NPIMap

Organization Active NPI

Doc on the Bay Associated Enterprises Incorporated

  • Internal Medicine Physician
  • Channelview, TX
National Provider Identifier
1285763268
Registry record updated Oct 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
H5715 Issued in TX
Legal business name
DOC ON THE BAY ASSOCIATED ENTERPRISES INCORPORATED
Practice address
15055 East Fwy Ste C10
Channelview, TX 77530-4142
Phone
(281) 452-3547
NPI assigned
Mar 5, 2007
Last updated
Oct 31, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2008

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

Authorized official

Name
Mrs. Laurie Killam, OTRL
Title
Office Manager
Phone
(281) 452-3547

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X H5715 TX Primary

Addresses

Primary practice location

15055 East Fwy Ste C10
Channelview, TX 77530-4142

Mailing address

15055 East Fwy Ste C10
Channelview, TX 77530-4142
Phone (281) 452-3547

Other identifiers 5

IdentifierTypeStateIssuer
111525501MedicaidTX
193614801MedicaidTX
111525504MedicaidTX
11525501MedicaidTX
00630VOtherTXBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

15055 East Fwy
Ste A20
Channelview, TX 77530
Phone (281) 452-3547

701 Bradford Ave
Apt A
Kemah, TX 77565
Phone (281) 334-7770

1560 Live Oak St
Webster, TX 77598
Phone (281) 338-0021

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225411200000",
    "number": "1285763268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15055 EAST FWY STE C10",
            "city": "CHANNELVIEW",
            "state": "TX",
            "postal_code": "775304142",
            "telephone_number": "281-452-3547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15055 EAST FWY STE C10",
            "city": "CHANNELVIEW",
            "state": "TX",
            "postal_code": "775304142",
            "telephone_number": "281-452-3547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOC ON THE BAY ASSOCIATED ENTERPRISES INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2008-10-31",
        "status": "A",
        "authorized_official_last_name": "KILLAM",
        "authorized_official_first_name": "LAURIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "281-452-3547",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "OTRL"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "H5715",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111525501",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "193614801",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111525504",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11525501",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "00630V",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Channelview, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.