Clive Gomilla, NP-C
Individual provider Active NPI Family Nurse Practitioner · Humble, TX
NPI 1568047249 · NPPES record last updated Aug 25, 2021
Key facts
- NPI
- 1568047249
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 1031969 (TX)
- Practice address
- 18980 W Memorial Dr
#100
Humble, TX 77338 - Phone
- (832) 644-8930
- NPI assigned
- Mar 14, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- University of Texas Medical Branch at Galveston, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Houston Cardiovascular Assoc PA
Practice addresses (Care Compare)
20710 Westheimer Pkwy
Katy, TX 77450-6256
Phone (281) 646-9000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211014000044 | TX | Practitioner - Nurse Practitioner | 1355749839 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1031969 | TX | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Houston Cardiovascular Assoc PA | Family | Current |
Accepting new patients |
| Houston Cardiovascular Assoc PA | Current |
Accepting new patients |
Locations
341 Cool Springs Blvd
Ste 305
Franklin, TN 37067
Phone (972) 391-1915
6441 Main St
Houston, TX 77030
Phone (713) 790-0500
18400 Katy Fwy
Ste 670
Houston, TX 77094
Phone (281) 398-4944
915 Gessner Rd
Ste 900
Houston, TX 77024
Phone (713) 464-0762
20710 Westheimer Pkwy
Katy, TX 77450
Phone (281) 646-9000
16605 Southwest Fwy
Ste 360
Sugar Land, TX 77479
Phone (713) 558-9508
Interoperability endpoints
- clive.gomilla@ushv.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 1031969 | TX | Yes |
Addresses
Primary practice location
18980 W Memorial Dr
#100
Humble, TX 77338
Mailing address
2123 Endicott LN
Sugar Land, TX 77478-6027
Phone (832) 875-5762
Other providers in Humble, TX
- Susan C Godson
- Tiara Golden
- Douglas Rudolph Goldstein
- Chloe Goltl
- Karen Liseth Gomez
- Ayrielle Gonzalez
- Celsio Gonzalez
- Jazmin De Abril Gonzalez
- Juan Manuel Gonzalez Jr.
- Nino Alissandro Gonzalez
All providers in Humble, TX · Family Nurse Practitioner in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 25, 2021. 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.
- Order and Referring (CMS).
- 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.