Nang Immanivong

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP126583 Issued in TX

Practice address

1515 Holcombe Blvd
Houston, TX 77030-4009

Phone

(713) 792-6161

NPI assigned

Dec 15, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Villagemd of Southeast Texas PAGroup PAC ID 4587947346, 217 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Houston Methodist Willowbrook Hospital Hospital, Houston, TX, CCN 450844

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nang.immanivong.1@13711.direct.athenahealth.com

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.

• Villagemd of Southeast Texas, PA

  • Family Medicine Physician
  • Houston, TX
  • NPI 1841643327

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• Minuteclinic Diagnostic of Texas PLLC

  • Family Nurse Practitioner
  • Round Rock, TX
  • NPI 1609076330
  Medicare reassignment NPD
• Minuteclinic Diagnostic of Texas PLLC

  • Clinical Social Worker
  • Katy, TX
  • NPI 1740898188
  NPD
• Village Family Practice, L.L.P

  • Family Medicine Physician
  • Houston, TX
  • NPI 1083619191
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Methodist Health Centers

  dba Houston Methodist Willowbrook Hospital

  • General Acute Care Hospital
  • Houston, TX
  • NPI 1871619254
  Care Compare affiliation

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

{
    "created_epoch": "1418601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519862400000",
    "number": "1538567102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4439",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772104439",
            "telephone_number": "713-792-2991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 HOLCOMBE BLVD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770304009",
            "telephone_number": "713-792-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMMANIVONG",
        "first_name": "NANG",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-15",
        "last_updated": "2018-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP126583 / RN 732786",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP126583",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "341880801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Immaculate EMS, Inc (immaculate medical supply)
• Immaculate Home Care
• Immaculate Living Care, LLC
• Immaculate Nursing LLC
• Immaculate Transportation LLC
• Immanuel Dental Center
• Josepha Immanuel, M.D
• Kevin Emitseilu Immanuel, M.D
• Oluchi Ibekwe Immanuel, MD
• Immediate Care Centers LLC

• Family Nurse Practitioner in Houston, TX
• Providers in Houston, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2018; 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.
• 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.