Family Healthcare Affiliates PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

FAMILY HEALTHCARE AFFILIATES PLLC

Practice address

800 Riverwood CT
Suite 105
Conroe, TX 77304-2890

Phone

(936) 760-4454

Fax

(936) 760-4415

NPI assigned

May 24, 2006

Organization subpart

No

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

Authorized official

Name

Krystal Urban

Title

Office Manager

Phone

(936) 760-4454

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 5

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

• Kara Kern, M.D.

  • Family Medicine Physician
  • Conroe, TX
  • NPI 1811984321
  Medicare reassignment Care Compare group NPD
• Maribeth Dudley Moore, D.O.

  • Family Medicine Physician
  • Conroe, TX
  • NPI 1376530758
  Medicare reassignment Care Compare group NPD
• Ashley Cox

  • Family Nurse Practitioner
  • Conroe, TX
  • NPI 1023648037
  Medicare reassignment NPD
• Amanda May Shankle, FNP-C

  • Family Nurse Practitioner
  • Conroe, TX
  • NPI 1023867462
  NPD
• William A Fridley, M.D.

  • Internal Medicine Physician
  • Shenandoah, TX
  • NPI 1760456545
  NPD (past)

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279497600000",
    "number": "1366497364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 RIVERWOOD CT",
            "address_2": "SUITE 105",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773042890",
            "telephone_number": "936-760-4454",
            "fax_number": "936-760-4415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 RIVERWOOD CT",
            "address_2": "SUITE 105",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773042890",
            "telephone_number": "936-760-4454",
            "fax_number": "936-760-4415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTHCARE AFFILIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2010-07-19",
        "status": "A",
        "authorized_official_last_name": "URBAN",
        "authorized_official_first_name": "KRYSTAL",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "936-760-4454"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "157678701",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0088HZ",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yazil Aracoeli Faires, FNP-C
• Nicole Fakes, DO
• Alifiya Fakhri, M.D.
• Zainab Yetunde Falana
• Family Enrichment and Play Therapy Center Inc
• Family Medicine Associates of Conroe PLLC
• Family Smiles Dental of Conroe PC
• Quinn Jodi Fan
• Justin Fang
• Mary-Ann Fares, MD

• Family Medicine Physician in Conroe, TX
• Providers in Conroe, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2010; 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.