NPIMap

Organization Active NPI

Northside Pediatrics Associates, PA

  • Pediatrics Physician
  • Conroe, TX
National Provider Identifier
1669928883
Registry record updated Apr 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
K4516 Issued in TX
Legal business name
NORTHSIDE PEDIATRICS ASSOCIATES, PA
Practice address
15210 I-45 South
Suite 110
Conroe, TX 77384-4105
Phone
(936) 270-8655
NPI assigned
Aug 28, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2017

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

Authorized official

Name
Dr. Michael E Okogbo, M.D.NPI 1043224132
Title
Owner
Phone
(806) 626-3808

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X K4516 TX Primary

Addresses

Primary practice location

15210 I-45 South
Suite 110
Conroe, TX 77384-4105

Mailing address

15210 I-45 S
Suite 110
Conroe, TX 77384-4105
Phone (936) 270-8655

Other identifiers 2

IdentifierTypeStateIssuer
1043224132OtherTXNPI
1609104785OtherTXNPI

National Provider Directory

National Provider Directory

Locations

500 Medical Center Blvd
Ste 350
Conroe, TX 77304
Phone (936) 270-8655

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/ECCJAD

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1472342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492560000000",
    "number": "1669928883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15210 I-45 S",
            "address_2": "SUITE 110",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773844105",
            "telephone_number": "936-270-8655",
            "fax_number": "936-270-8739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15210 I-45 SOUTH",
            "address_2": "SUITE 110",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773844105",
            "telephone_number": "936-270-8655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE PEDIATRICS ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-28",
        "last_updated": "2017-04-19",
        "status": "A",
        "authorized_official_last_name": "OKOGBO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "806-626-3808",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "K4516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1043224132",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1609104785",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.