Individual provider Active NPI

Shayan Alireza Izaddoost, M.D., PH.D.

  • Plastic and Reconstructive Surgery Physician
  • Houston, TX
National Provider Identifier
1457599706
Registry record updated Sep 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
N0850 Issued in TX
Practice address
2727 W Holcombe Blvd
Houston, TX 77025-1669
Phone
(713) 442-0000
NPI assigned
Jan 24, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X N0850 TX
Plastic and Reconstructive Surgery Physician 2086S0122X N0850 TX Primary

Addresses

Primary practice location

2727 W Holcombe Blvd
Houston, TX 77025-1669

Mailing address

11511 Shadow Creek Pkwy
Pearland, TX 77584-7298
Phone (713) 442-0000

Other identifiers 2

IdentifierTypeStateIssuer
204706009MedicaidTX
204706010MedicaidTX

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090804000145 TX Practitioner - Plastic and Reconstructive Surgery 6002969342 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
N0850TXMDPlastic and Reconstructive Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baylor College of Medicine CurrentSince Jul 1, 2009 Accepting new patients
Kelsey-Seybold Medical Group, PLLC CurrentSince Aug 16, 2021 Accepting new patients
Baylor College of Medicine CurrentSince Jul 1, 2009 Accepting new patients
Baylor College of Medicine CurrentSince Jan 1, 2014 Accepting new patients
Memorial Plastic Surgery, LLLP CurrentSince Feb 1, 2020 Accepting new patients
Baylor College of Medicine Plastic Surgery CurrentSince Jan 1, 2014 Accepting new patients
Baylor College of Medicine Plastic Surgery Past Accepting new patients

Locations

2 Greenway Plz
Ste 900
Houston, TX 77046
Phone (713) 798-1835

6560 Fannin St
Ste 800
Houston, TX 77030
Phone (713) 798-6101

8731 Katy Fwy
Ste 500
Houston, TX 77024
Phone (713) 633-4411

1504 Taub Loop
Houston, TX 77030
Phone (713) 873-2860

2727 W Holcombe Blvd
Houston, TX 77025
Phone (713) 790-9412

1977 Butler Blvd
Houston, TX 77030
Phone (713) 798-4857

1977 Butler Blvd
Fl 6
Houston, TX 77030
Phone (713) 798-6131

7200 Cambridge St
Fl 1
Houston, TX 77030
Phone (713) 798-3924

7010 Highway 6
Missouri City, TX 77459
Phone (713) 442-4200

11511 Shadow Creek Pkwy
Pearland, TX 77584
Phone (713) 442-4997

2515 Business Center Dr
Pearland, TX 77584
Phone (713) 442-7200

Interoperability endpoints

  • Direct secure messaging: sizaddoost37925@direct.kelsey-seybold.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1232755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1457599706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11511 SHADOW CREEK PKWY",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775847298",
            "telephone_number": "713-442-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2727 W HOLCOMBE BLVD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770251669",
            "telephone_number": "713-442-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IZADDOOST",
        "first_name": "SHAYAN",
        "middle_name": "ALIREZA",
        "name_prefix": "Dr.",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-24",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "TX",
            "license": "N0850",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "TX",
            "license": "N0850",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204706009",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204706010",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.