Centerwell Senior Primary Care (TX) PA
Organization Active NPI Internal Medicine Physician · Houston, TX
NPI 1447717871 · NPPES record last updated Oct 18, 2022
Key facts
- NPI
- 1447717871
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- CENTERWELL SENIOR PRIMARY CARE (TX) PA
- Practice address
- 5104 Harrisburg Blvd Ste 800
Houston, TX 77011-0001 - Phone
- (832) 667-4150
- Fax
- (833) 853-9420
- NPI assigned
- Feb 21, 2019
- Organization subpart
- Yes
- Parent organization (as reported)
- CENTERWELL SENIOR PRIMARY CARE (TX) PA
Authorized official
- Name
- Angie Martinez
- Title
- Senior Credentialing Professional
- Phone
- (407) 447-7120
Other NPIs on the same Medicare enrollment 35
Corporate family (same tax ID) 29
Practitioners 62
-
James R. McClamroch, M.D.
-
Son Van Nguyen, MD
-
Carolina Aceves, FNP-C
-
Shaina Jayde Arellano, FNP-BC
-
Heather Renee Bartsch, M.D.
-
Larah Brown, NP
-
Karina Sanjuanita Cantu, APRN, FNP-BC
-
Juan G. Castillo, M.D.
-
Niru Cepeda-Iruegas, M.D.
-
Reyna Alejandra Chavarri, MPAS, PA-C
-
Ginaida Cirilo, M.D.
-
Irvin Del Angel, MD
-
Erick Del Monte, PA-C
-
Theodore J Disque, FNP
-
Jose Luis Duran, APRN, FNP-C
-
Andrew A Evans, MD
-
Olga Lucila Garces-Vega, APRN-CNP, AGPCNP-C
-
Gustavo Garza, PA
-
Juan Carlos Gavalda, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2167091 | Centerwell Senior Primary Care (TX) PA Dba | Certificate of waiver | May 30, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190327001232 | TX | Part B Supplier - Clinic/Group Practice | 4789950247 |
Receives reassigned benefits from 132 practitioners 35 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Houston, TX; Humble, TX; McAllen, TX; Pantego, TX; Pasadena, TX; Port Arthur, TX; Richardson, TX; Richland Hills, TX… |
National Provider Directory
- Tax ID family
- Centerwell Senior Primary Care TX PA
- Part of
- Centerwell Senior Primary Care TX PA
Locations
16575 W 119th St
Olathe, KS 66061
Phone (913) 815-5008
6515 Garth Rd
Ste 150
Baytown, TX 77521
Phone (346) 660-3366
3701 W Northwest Hwy
Ste 235
Dallas, TX 75220
Phone (214) 366-1133
1205 Northwest Hwy
Garland, TX 75041
Phone (469) 936-0541
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | Yes | ||
| General Practice Physician |
208D00000X |
Addresses
Primary practice location
5104 Harrisburg Blvd Ste 800
Houston, TX 77011-0001
Mailing address
4700 Millenia Blvd Ste 650
Orlando, FL 32839-6013
Phone (407) 447-7120
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 792121 | Other | TX | MEDICARE |
| 4089997-01 | Medicaid | TX |
Other names
- CenterWell Senior Primary Care -Downtown East
- Partners In Primary Care TX, PA
- Partners In Primary Care- Downtown East
Other providers in Houston, TX
- Centerwell Senior Primary Care (TX) PA
- Centerwell Senior Primary Care (TX) PA
- Centerwell Senior Primary Care (TX) PA
- Centerwell Senior Primary Care (TX) PA
- Centerwell Senior Primary Care (TX) PA
- Centerwell Senior Primary Care (TX) PA
- Centerwell Senior Primary Care (TX) PA
- Centerwell Senior Primary Care (TX) PA
- Ida Centineo
- Frank Centonze
All providers in Houston, TX · Internal Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.