Active NPI
Alisara Suptuesat, M.D.
- Diagnostic Radiology Physician
- Houston, TX
National Provider Identifier
1205922978
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 42742
- Practice address
- 6411 Fannin
Houston, TX 77030 - Phone
- (713) 704-4000
- NPI assigned
- Oct 4, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | FTL 41869 | TX | |
| Diagnostic Radiology Physician | 2085R0202X | 42742 | TX | Primary |
Addresses
Primary practice location
6411 Fannin
Houston, TX 77030
Mailing address
P O Box 201088
Houston, TX 77216-1088
Phone (713) 500-3500
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 187729202 | Other | TX | CSHCN |
| 8W2045 | Other | TX | BCBS |
| 187729201 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42742 | TX | MD | Pharmacist |
| FTL 41869 | TX | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ut Imaging - Houston LLP | Diagnostic Radiology | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Diagnostic Radiology Physician
- Bellaire, TX
- NPI 1073562682
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255392000000",
"number": "1205922978",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P O BOX 201088",
"city": "HOUSTON",
"state": "TX",
"postal_code": "772161088",
"telephone_number": "713-500-3500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6411 FANNIN",
"city": "HOUSTON",
"state": "TX",
"postal_code": "77030",
"telephone_number": "713-704-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUPTUESAT",
"first_name": "ALISARA",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-04",
"last_updated": "2009-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "TX",
"license": "FTL 41869",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "TX",
"license": "42742",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CSHCN",
"identifier": "187729202",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "8W2045",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "187729201",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.