NPIMap

Organization Active NPI

Centerwell Senior Primary Care (TX) PA

  • Internal Medicine Physician
  • Port Arthur, TX
National Provider Identifier
1568094282
Registry record updated Oct 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CENTERWELL SENIOR PRIMARY CARE (TX) PA
Practice address
8555 Memorial Blvd Ste 100
Port Arthur, TX 77640-7001
Phone
(409) 237-6480
Fax
(833) 749-0330
NPI assigned
Feb 11, 2020
Organization subpart
Yes
Parent organization
PARTNERS IN PRIMARY CARE TX, PAAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Angie Martinez
Title
Senior Credentialing Professional
Phone
(407) 447-7120

Other NPIs on the same Medicare enrollment 35

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 35

Corporate family (same tax ID) 29

Organizations that report the same tax identification number in the National Provider Directory.

View all 29

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2179845Centerwell Senior Primary Care (TX) PA Dba8555 Memorial Blvd, Suite 100, Port Arthur, TX 77640Certificate of waiverMar 2, 2028

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
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

National Provider Directory
Tax ID family
Centerwell Senior Primary Care TX PA (30 organizations share this tax ID)
Part of
Centerwell Senior Primary Care TX PA

Locations

4435 W Fuqua St
Houston, TX 77045
Phone (713) 581-6897

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X

Addresses

NPPES NPI Registry

Primary practice location

8555 Memorial Blvd Ste 100
Port Arthur, TX 77640-7001

Mailing address

4700 Millenia Blvd Ste 650
Orlando, FL 32839-6013
Phone (407) 447-7120

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
4179707-01MedicaidTX
1C6598OtherTXMEDICARE

Other names 4

NPPES NPI Registry
  • CenterWell Senior Primary Care - Port Arthur Doing business as
  • Partners In Primary Care TX, PA Former legal business name
  • Partners In Primary Care- Port Arthur Former legal business name
  • Partners in Primary Care KS, PA Former legal business name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 18, 2022.

{
    "created_epoch": "1581379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666051200000",
    "number": "1568094282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 MILLENIA BLVD STE 650",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328396013",
            "telephone_number": "407-447-7120",
            "fax_number": "407-770-0661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8555 MEMORIAL BLVD STE 100",
            "city": "PORT ARTHUR",
            "state": "TX",
            "postal_code": "776407001",
            "telephone_number": "409-237-6480",
            "fax_number": "833-749-0330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERWELL SENIOR PRIMARY CARE (TX) PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PARTNERS IN PRIMARY CARE TX, PA",
        "enumeration_date": "2020-02-11",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "SENIOR CREDENTIALING PROFESSIONAL",
        "authorized_official_telephone_number": "407-447-7120"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4179707-01",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "1C6598",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CenterWell Senior Primary Care - Port Arthur",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Partners In Primary Care TX, PA",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Partners In Primary Care- Port Arthur",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Partners in Primary Care KS, PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Port Arthur, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.