NPIMap

Organization Active NPI

Memorial Hermann Surgery Center Preston Road, LTD.

Doing business as Doctors Outpatient Surgicenter

  • Ambulatory Surgical Clinic/Center
  • Pasadena, TX
National Provider Identifier
1619971504
Registry record updated Jul 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
007116 Issued in TX
Legal business name
MEMORIAL HERMANN SURGERY CENTER PRESTON ROAD, LTD.
Doing business as
Doctors Outpatient Surgicenter
Practice address
3534 Vista Rd
Pasadena, TX 77504-1728
Phone
(713) 947-0330
Fax
(713) 947-6562
NPI assigned
Jun 8, 2005
Last updated
Jul 24, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2019

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

Authorized official

Name
Jenetha D Moran
Title
Officer / Authorized Official
Phone
(972) 763-3893

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 007116 TX Primary

Addresses

Primary practice location

3534 Vista Rd
Pasadena, TX 77504-1728

Mailing address

3534 Vista Rd
Pasadena, TX 77504-1728
Phone (713) 947-0330

Other identifiers 2

IdentifierTypeStateIssuer
10021532MedicaidTX
490004677OtherTXRAILROAD MEDICARE

Other names 1

  • Doctors Outpatient Surgicenter Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091015000387 TX Part B Supplier - Ambulatory Surgical Center 0244376606 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pasadena, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619971504. Details of each certification follow.

Ambulatory surgical center certification: CCN 45C0001009

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
DOCTORS SURGICENTER
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Jun 6, 1983
Last certification
Jul 29, 2016
Ownership / control type
Proprietary
Facility address
3534 Vista
Pasadena, TX 77504

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563926400000",
    "number": "1619971504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3534 VISTA RD",
            "city": "PASADENA",
            "state": "TX",
            "postal_code": "775041728",
            "telephone_number": "713-947-0330",
            "fax_number": "713-947-6562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3534 VISTA RD",
            "city": "PASADENA",
            "state": "TX",
            "postal_code": "775041728",
            "telephone_number": "713-947-0330",
            "fax_number": "713-947-6562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HERMANN SURGERY CENTER PRESTON ROAD, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-08",
        "last_updated": "2019-07-24",
        "status": "A",
        "authorized_official_last_name": "MORAN",
        "authorized_official_first_name": "JENETHA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OFFICER / AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "972-763-3893"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TX",
            "license": "007116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10021532",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "490004677",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Doctors Outpatient Surgicenter",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Doctors Outpatient Surgicenter",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pasadena, TX

Sources for this page

Verify at the official NPI Registry.