Active NPI
Havana Medical Group Corp
Doing business as Clinica Havana
- Family Nurse Practitioner
- Houston, TX
National Provider Identifier
1679270623
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- Legal business name
- HAVANA MEDICAL GROUP CORP
- Doing business as
- Clinica Havana
- Practice address
- 715 Telephone Rd
Houston, TX 77023-3117 - Phone
- (832) 871-4777
- Fax
- (832) 871-4776
- NPI assigned
- Feb 9, 2023
- Last updated
- Mar 31, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Norbe Luis Basulto Barcelay, NP
- Title
- Director
- Phone
- (786) 556-8819
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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | NU | ||
| Family Nurse Practitioner | 363LF0000X | NU | Primary |
Addresses
Primary practice location
715 Telephone Rd
Houston, TX 77023-3117
Mailing address
715 Telephone Rd
Houston, TX 77023-3117
Phone (832) 871-4777
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861628505 | Other | TX | BLUE CROSS BLUE SHIELD |
| 1861628505 | Other | TX | UNITED HEALTH CARE |
| 1861628505 | Other | AETNA | |
| 1861628505 | Medicaid | TX | |
| 1861628505 | Other | TX | MOLINA |
| 1861628505 | Other | TX | COMMUNITY HEALTH CHOICE |
Other names 1
- Clinica Havana
National Provider Directory
National Provider Directory- Tax ID family
- Havana Medical Group Corp
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
Ownership & related parties
Subparts reporting this organization as parent 1
Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.
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.
-
- Family Nurse Practitioner
- Katy, TX
- NPI 1861628505
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1675900800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1680220800000",
"number": "1679270623",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "715 TELEPHONE RD",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770233117",
"telephone_number": "832-871-4777",
"fax_number": "832-871-4776"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "715 TELEPHONE RD",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770233117",
"telephone_number": "832-871-4777",
"fax_number": "832-871-4776"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HAVANA MEDICAL GROUP CORP",
"organizational_subpart": "NO",
"enumeration_date": "2023-02-09",
"last_updated": "2023-03-31",
"certification_date": "2023-03-31",
"status": "A",
"authorized_official_last_name": "BASULTO BARCELAY",
"authorized_official_first_name": "NORBE",
"authorized_official_middle_name": "LUIS",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "786-556-8819",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "NP"
},
"taxonomies": [
{
"code": "261QP2300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Primary Care",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "1861628505",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "1861628505",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "1861628505",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1861628505",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MOLINA",
"identifier": "1861628505",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMUNITY HEALTH CHOICE",
"identifier": "1861628505",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Clinica Havana",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Clinica Havana",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.