Mount Carmel Medical Clinic PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

MOUNT CARMEL MEDICAL CLINIC PLLC

Practice address

11230 Airline Dr Ste#1
Houston, TX 77037-1116

Phone

(832) 810-9521

Fax

(855) 703-1949

NPI assigned

Jul 9, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Blessy S Jacob, DNPNPI 1831499029

Title

Medical Director

Phone

(832) 810-9521

Specialties & licenses 3

Addresses

Other identifiers 2

Electronic endpoints 1

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 1

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

• Blessy S Jacob, DNP

  • Primary Care Nurse Practitioner
  • Houston, TX
  • NPI 1831499029
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1594252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717027200000",
    "number": "1376161075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11230 AIRLINE DR STE#1",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770371116",
            "telephone_number": "832-810-9521",
            "fax_number": "855-703-1949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11230 AIRLINE DR STE#1",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770371116",
            "telephone_number": "832-810-9521",
            "fax_number": "855-703-1949"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2714 Cypress Point Dr Ste#A",
            "address_purpose": "LOCATION",
            "city": "Missouri City",
            "state": "TX",
            "postal_code": "774592600",
            "country_code": "US",
            "telephone_number": "713-703-7684",
            "fax_number": "855-703-1949",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MOUNT CARMEL MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-09",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A",
        "authorized_official_last_name": "JACOB",
        "authorized_official_first_name": "BLESSY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "832-810-9521",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4213043",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3153637",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "TEBRA.COM",
            "affiliation": "N",
            "endpointDescription": "USED TO BE KAREO.COM",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "EMR",
            "address_1": "11230 AIRLINE DR, STE#1",
            "city": "HOUSTON",
            "state": "TX",
            "country_code": "US",
            "postal_code": "770371116",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kimin Kim Moulton, PH.D,L.AC.
• Sharon Denise Moulton, CRNP-FAMILY
• Stacey Moultrie
• Aisha Morris Moultry, PHARMD
• Semaj M Mounger, BCBA
• Mount Olive Hospice and Palliative Care LLC
• Mount Pediatric and Family Clinic LLC
• Priscila Emi Nakano Mount, MSN, APRN, CPNP-AC
• Mountain Care Pharmacy Houston LLC
• Mountain Movers Counseling PLLC

• Primary Care Clinic/Center in Houston, TX
• Providers in Houston, TX by specialty
• Primary Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; 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.