Individual provider Active NPI

Jonathan Ingusan Santos, M.D.

  • Family Medicine Physician
  • Conroe, TX
National Provider Identifier
1306158803
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
P4108 Issued in TX
Practice address
605 S Conroe Medical Dr
Conroe, TX 77304-4722
Phone
(936) 539-4004
Fax
(936) 539-3635
NPI assigned
Jul 13, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X P4108 TX Primary

Addresses

Primary practice location

605 S Conroe Medical Dr
Conroe, TX 77304-4722

Mailing address

605 S Conroe Medical Dr
Conroe, TX 77304-4722
Phone (936) 539-4004

Other identifiers 1

IdentifierTypeStateIssuer
3201014-01MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130603000402 TX Practitioner - Family Practice 4082852041 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lone Star Community Health Center, IncGroup PAC ID 7416841994, 35 clinicians

Practice addresses (Care Compare)

440 Rayford Rd
Suite 150
Spring, TX 77386-4169
Phone (936) 539-4004

Hospital & facility affiliations

  • HCA Houston Healthcare Conroe Hospital, Conroe, TX, CCN 450222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
P4108TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lone Star Community Health Center, Inc. Family Medicine CurrentSince Jul 1, 2013 Accepting new patients
Lone Star Community Health Center, Inc. CurrentSince Jul 1, 2013 Accepting new patients
Chca Conroe LP Past Accepting new patients
Lone Star Community Health Center, Inc. Family Medicine Past Accepting new patients

Locations

13905 Grangerland Rd
Conroe, TX 77306

605 S Conroe Medical Dr
Conroe, TX 77304

440 Rayford Rd
Ste 150
Spring, TX 77386

9516 FM 1097 Rd W
Ste 140
Willis, TX 77318
Phone (936) 436-5540

Interoperability endpoints

  • Direct secure messaging: jonathansantos@lsfhc.allscriptsdirect.net

Organizations & group practices 4

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1278979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1306158803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 S CONROE MEDICAL DR",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773044722",
            "telephone_number": "936-539-4004",
            "fax_number": "936-539-3635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 S CONROE MEDICAL DR",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773044722",
            "telephone_number": "936-539-4004",
            "fax_number": "936-539-3635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTOS",
        "first_name": "JONATHAN",
        "middle_name": "INGUSAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-13",
        "last_updated": "2023-03-07",
        "certification_date": "2021-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "P4108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3201014-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

Verify at the official NPI Registry.