Active NPI
Renita Madu, P.A.
- Medical Physician Assistant
- Pearland, TX
National Provider Identifier
1376774869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA05780
- Practice address
- 12004 Shadow Creek Pkwy
Suite 121
Pearland, TX 77584-7326 - Phone
- (281) 968-9290
- Fax
- (281) 463-1432
- NPI assigned
- Jul 31, 2009
- Last updated
- Apr 25, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA05780 | TX | Primary |
Addresses
Primary practice location
12004 Shadow Creek Pkwy
Suite 121
Pearland, TX 77584-7326
Mailing address
12004 Shadow Creek Pkwy
Suite 121
Pearland, TX 77584-7326
Phone (281) 968-9290
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: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA05780 | TX | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| City of Houston | Current | Accepting new patients | |
| South Central Houston Action Council, Inc. | Past | Accepting new patients |
Locations
8000 N Stadium Dr
Fl 7
Houston, TX 77054
Phone (713) 794-9104
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Central Care Community Health Center - Riverside
- Federally Qualified Health Center (FQHC)
- Houston, TX
- NPI 1821177866
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366848000000",
"number": "1376774869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12004 SHADOW CREEK PKWY",
"address_2": "SUITE 121",
"city": "PEARLAND",
"state": "TX",
"postal_code": "775847326",
"telephone_number": "281-968-9290",
"fax_number": "281-463-1432"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12004 SHADOW CREEK PKWY",
"address_2": "SUITE 121",
"city": "PEARLAND",
"state": "TX",
"postal_code": "775847326",
"telephone_number": "281-968-9290",
"fax_number": "281-463-1432"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADU",
"first_name": "RENITA",
"name_prefix": "Ms.",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-07-31",
"last_updated": "2013-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "TX",
"license": "PA05780",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pearland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.