Organization Active NPI

Prestige Medical P a

  • Family Medicine Physician
  • Manvel, TX
National Provider Identifier
1174654750
Registry record updated Feb 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
L7625 Issued in TX
Legal business name
PRESTIGE MEDICAL P A
Practice address
3945 County Road 58
Manvel, TX 77578-2903
Phone
(281) 412-6606
Fax
(281) 489-0233
NPI assigned
Mar 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jeevan R Santha
Title
Practice Manager
Phone
(281) 923-4112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X L7625 TX Primary

Addresses

Primary practice location

3945 County Road 58
Manvel, TX 77578-2903

Mailing address

3945 County Road 58
Manvel, TX 77578-2903
Phone (281) 412-6606

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070910000492 TX Part B Supplier - Clinic/Group Practice 7810080637 Receives reassigned benefits from 1 practitioner
Practice locations: Manvel, TX

National Provider Directory

National Provider Directory

Locations

9223 Broadway St
Ste 107
Pearland, TX 77584
Phone (281) 923-4112

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770595200000",
    "number": "1174654750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3945 COUNTY ROAD 58",
            "city": "MANVEL",
            "state": "TX",
            "postal_code": "775782903",
            "telephone_number": "281-412-6606",
            "fax_number": "281-489-0233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3945 COUNTY ROAD 58",
            "city": "MANVEL",
            "state": "TX",
            "postal_code": "775782903",
            "telephone_number": "281-412-6606",
            "fax_number": "281-489-0233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE MEDICAL P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2026-02-09",
        "certification_date": "2026-02-09",
        "status": "A",
        "authorized_official_last_name": "SANTHA",
        "authorized_official_first_name": "JEEVAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "281-923-4112",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L7625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manvel, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.