Organization Active NPI

Digestive Disease Consultants PA

  • Gastroenterology Physician
  • Humble, TX
National Provider Identifier
1376629964
Registry record updated Jul 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
DIGESTIVE DISEASE CONSULTANTS PA
Practice address
9816 Memorial Blvd
#206
Humble, TX 77338
Phone
(281) 446-8114
Fax
(281) 446-1158
NPI assigned
Oct 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2008

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

Authorized official

Name
Mrs. Starr Lee Wallace, LVN
Title
LVN Office Manager
Phone
(281) 446-8114

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

9816 Memorial Blvd
#206
Humble, TX 77338

Mailing address

9816 Memorial Blvd
#206
Humble, TX 77338
Phone (281) 446-8114

Other identifiers 1

IdentifierTypeStateIssuer
081671201MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041008000554 TX Part B Supplier - Clinic/Group Practice 5890754402 Receives reassigned benefits from 1 practitioner
Practice locations: Humble, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215561600000",
    "number": "1376629964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9816 MEMORIAL BLVD",
            "address_2": "#206",
            "city": "HUMBLE",
            "state": "TX",
            "postal_code": "77338",
            "telephone_number": "281-446-8114",
            "fax_number": "281-446-1158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9816 MEMORIAL BLVD",
            "address_2": "#206",
            "city": "HUMBLE",
            "state": "TX",
            "postal_code": "77338",
            "telephone_number": "281-446-8114",
            "fax_number": "281-446-1158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIGESTIVE DISEASE CONSULTANTS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2008-07-09",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "STARR",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "LVN OFFICE MANAGER",
        "authorized_official_telephone_number": "281-446-8114",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LVN"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "081671201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Humble, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.