NPIMap

Individual provider Active NPI

Ronald M Pucillo, M.D.

  • Family Medicine Physician
  • Sugar Land, TX
National Provider Identifier
1548263106
Registry record updated Sep 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G2207 Issued in TX
Practice address
16659 Southwest Fwy # 461
Sugar Land, TX 77479-2375
Phone
(281) 340-9355
Fax
(281) 340-9366
NPI assigned
May 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X G2207 TX Primary

Addresses

Primary practice location

16659 Southwest Fwy # 461
Sugar Land, TX 77479-2375

Mailing address

16659 Southwest Fwy # 461
Sugar Land, TX 77479-2375
Phone (281) 340-9355

Other identifiers 1

IdentifierTypeStateIssuer
8BA000OtherTXBC/BS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070523000437 TX Practitioner - Family Practice 4385741651 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York Medical College, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

7900 Fannin St
Suite 4000
Houston, TX 77054-2935
Phone (713) 512-7500

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group Gulf Coast PLLC CurrentSince Aug 16, 2017 Accepting new patients
Privia Medical Group Gulf Coast, PLLC CurrentSince Aug 16, 2017 Accepting new patients
Santa Clara Family Clinic PLLC Family Medicine Past Accepting new patients

Locations

646 FM 517 Rd W
Dickinson, TX 77539
Phone (281) 309-9001

7900 Fannin St
Ste 4000
Houston, TX 77054
Phone (713) 512-7027

10970 Shadow Creek Pkwy
Ste 100
Pearland, TX 77584
Phone (281) 398-8500

1111 Highway 6
Ste 40
Sugar Land, TX 77478
Phone (281) 340-9355

16659 Southwest Fwy
Ste 461
Sugar Land, TX 77479
Phone (281) 340-9355

17510 W Grand Pkwy S
Ste 430
Sugar Land, TX 77479
Phone (713) 578-3820

Interoperability endpoints

  • Direct secure messaging: ronald.pucillo.1@8042.direct.athenahealth.com
  • Direct secure messaging: ronald.pucillomd.p1@direct.tpma.nextgenshare.com

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 and National Provider Directory roles.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220313600000",
    "number": "1548263106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16659 SOUTHWEST FWY # 461",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "774792375",
            "telephone_number": "281-340-9355",
            "fax_number": "281-340-9366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16659 SOUTHWEST FWY # 461",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "774792375",
            "telephone_number": "281-340-9355",
            "fax_number": "281-340-9366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCILLO",
        "first_name": "RONALD",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-27",
        "last_updated": "2008-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "G2207",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "8BA000",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sugar Land, TX

Sources for this page

Verify at the official NPI Registry.