NPIMap

Organization Active NPI

Innovista Provider Group Texas PA

  • Family Medicine Physician
  • Houston, TX
National Provider Identifier
1346895828
Registry record updated Jun 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
INNOVISTA PROVIDER GROUP TEXAS PA
Practice address
12302 Jones Rd
Houston, TX 77070-4802
Phone
(305) 470-2929
NPI assigned
Aug 1, 2019
Organization subpart
Yes
Parent organization
INNOVISTA PROVIDER GROUP TEXAS PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 2, 2025

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

Authorized official

Name
Mia Willhite
Title
Coo
Phone
(317) 590-3862

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

12302 Jones Rd
Houston, TX 77070-4802

Mailing address

PO Box 8150
Westchester, IL 60154-8150
Phone (844) 665-4827

Other names 2

  • Innovista Willowbrook Doing business as
  • Innovista Medical Center of Texas PA Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200406000046 TX Part B Supplier - Clinic/Group Practice 6901235423 Receives reassigned benefits from 26 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Irving, TX; Spring, TX; Richardson, TX; Mesquite, TX; Katy, TX; Houston, TX

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2293148Innovista Medical Center Texas, LLC12302 Jones Rd, Houston, TX 77070Certificate of waiverNov 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Innovista Medical Center of Texas PA8 organizations share this tax ID, including this one
Part of
Innovista Medical Center of Texas PA

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

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": "1564617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748822400000",
    "number": "1346895828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8150",
            "city": "WESTCHESTER",
            "state": "IL",
            "postal_code": "601548150",
            "telephone_number": "844-665-4827",
            "fax_number": "877-862-5671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12302 JONES RD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770704802",
            "telephone_number": "305-470-2929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVISTA PROVIDER GROUP TEXAS PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INNOVISTA PROVIDER GROUP TEXAS PA",
        "enumeration_date": "2019-08-01",
        "last_updated": "2025-06-02",
        "certification_date": "2025-06-02",
        "status": "A",
        "authorized_official_last_name": "WILLHITE",
        "authorized_official_first_name": "MIA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "317-590-3862"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innovista Willowbrook",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Innovista Medical Center of Texas PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Jun 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.