NPIMap

Organization Active NPI

Provential Medical Group

  • Interventional Pain Medicine Physician
  • Katy, TX
National Provider Identifier
1669956942
Registry record updated Sep 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
PROVENTIAL MEDICAL GROUP
Practice address
21300 Provincial Blvd
Suite 200
Katy, TX 77450
Phone
(713) 562-7890
Fax
(281) 605-4566
NPI assigned
Sep 21, 2018
Last updated
Sep 21, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2018

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

Authorized official

Name
Mark Filley, MDNPI 1689698912
Title
Director
Phone
(281) 543-0012

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

21300 Provincial Blvd
Suite 200
Katy, TX 77450

Mailing address

10507 E Wildwind Cir
Spring, TX 77380-4043
Phone (281) 543-0012

National Provider Directory

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": "1537488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537488000000",
    "number": "1669956942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10507 E WILDWIND CIR",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773804043",
            "telephone_number": "281-543-0012",
            "fax_number": "281-605-4566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21300 PROVINCIAL BLVD",
            "address_2": "SUITE 200",
            "city": "KATY",
            "state": "TX",
            "postal_code": "77450",
            "telephone_number": "713-562-7890",
            "fax_number": "281-605-4566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVENTIAL MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-21",
        "last_updated": "2018-09-21",
        "status": "A",
        "authorized_official_last_name": "FILLEY",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "281-543-0012",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Katy, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2018; 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.