Gulf Coast Cancer & Diagnostic Center at Southeast

Primary specialty

Radiation Oncology Clinic/CenterTaxonomy code 261QX0203X

Legal business name

GULF COAST CANCER & DIAGNOSTIC CENTER AT SOUTHEAST

Practice address

12811 Beamer Rd
Houston, TX 77089-6140

Phone

(713) 474-1414

Fax

(713) 474-8477

NPI assigned

Jul 12, 2005

Organization subpart

No

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

Authorized official

Name

Mark A Dandrea, MDNPI 1326081993

Title

Owner

Phone

(713) 474-1414

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• University Diagnostic and Treatment Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Practitioners 1

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

• Mark A D'Andrea, M.D.

  • Radiation Oncology Physician
  • Houston, TX
  • NPI 1326081993
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461024000000",
    "number": "1194723296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7894",
            "city": "PASADENA",
            "state": "TX",
            "postal_code": "775087894",
            "telephone_number": "713-474-1414",
            "fax_number": "713-474-8477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12811 BEAMER RD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770896140",
            "telephone_number": "713-474-1414",
            "fax_number": "713-474-8477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST CANCER & DIAGNOSTIC CENTER AT SOUTHEAST",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-12",
        "last_updated": "2016-04-19",
        "status": "A",
        "authorized_official_last_name": "DANDREA",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "713-474-1414",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QX0203X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oncology, Radiation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149577201",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0212DC",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "University Diagnostic and Treatment Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Radiation Oncology Clinic/Center in Houston, TX
• Providers in Houston, TX by specialty
• Radiation Oncology Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2016; 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.