Organization Active NPI

S.G. Ghide, M.D,, P.a.

  • Infectious Disease Physician
  • Shenandoah, TX
National Provider Identifier
1679722425
Registry record updated Apr 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
K9282 Issued in TX
Legal business name
S.G. GHIDE, M.D,, P.A.
Practice address
1120 Medical Plaza Dr
Ste 310
Shenandoah, TX 77380-3242
Phone
(281) 732-5952
Fax
(281) 377-4733
NPI assigned
Sep 17, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2017

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

Authorized official

Name
Mr. Susan E Wiesner
Title
Credentialing/Administration
Phone
(281) 851-6431

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RI0200X K9282 TX Primary

Addresses

Primary practice location

1120 Medical Plaza Dr
Ste 310
Shenandoah, TX 77380-3242

Mailing address

PO Box 9840
The Woodlands, TX 77387-6840
Phone (281) 732-5952

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130103000467 TX Part B Supplier - Clinic/Group Practice 8729026349 Receives reassigned benefits from 1 practitioner
Practice locations: Shenandoah, TX

National Provider Directory

National Provider Directory

Locations

100 Medical Center Blvd
Ste 212
Conroe, TX 77304
Phone (281) 363-4944

Practitioners & affiliated clinicians

Practitioners 1

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": "1221609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493337600000",
    "number": "1679722425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9840",
            "city": "THE WOODLANDS",
            "state": "TX",
            "postal_code": "773876840",
            "telephone_number": "281-732-5952",
            "fax_number": "281-377-4733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 MEDICAL PLAZA DR",
            "address_2": "STE 310",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773803242",
            "telephone_number": "281-732-5952",
            "fax_number": "281-377-4733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S.G. GHIDE, M.D,, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-17",
        "last_updated": "2017-04-28",
        "status": "A",
        "authorized_official_last_name": "WIESNER",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CREDENTIALING/ADMINISTRATION",
        "authorized_official_telephone_number": "281-851-6431",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "TX",
            "license": "K9282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shenandoah, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.