Individual provider Active NPI

Kelly Cajahuaringa Castro, MD

  • Family Medicine Physician
  • Houston, TX
National Provider Identifier
1699765677
Registry record updated Dec 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
L1281 Issued in TX
Practice address
1111 Augusta Dr
Tanglewood Clinic
Houston, TX 77057-2209
Phone
(713) 442-2400
NPI assigned
Oct 21, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X L1281 TX Primary

Addresses

Primary practice location

1111 Augusta Dr
Tanglewood Clinic
Houston, TX 77057-2209

Mailing address

11511 Shadow Creek Pkwy
HR Credentialing Services
Pearland, TX 77584-7298
Phone (713) 442-0000

Other identifiers 3

IdentifierTypeStateIssuer
146571803MedicaidTX
146571805MedicaidTX
146571802MedicaidTX

Other names 1

  • Kelly C Cajahuaringa Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050104000586 TX Practitioner - Family Practice 5890743140 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Kelsey-Seybold Medical Group, PLLC Family Medicine CurrentSince Jan 5, 2004 Accepting new patients
Village Chiropractic and Wellness P.L.L.C. Past Accepting new patients

Locations

1111 Augusta Dr
Houston, TX 77057
Phone (713) 442-2400

6401 Woodway Dr
Houston, TX 77057
Phone (713) 442-2400

2727 W Holcombe Blvd
Houston, TX 77025
Phone (713) 790-9412

3023 Marina Bay Dr
Ste 104
League City, TX 77573
Phone (281) 334-7737

7010 Highway 6
Missouri City, TX 77459
Phone (713) 442-4200

11511 Shadow Creek Pkwy
Pearland, TX 77584
Phone (713) 442-4997

2515 Business Center Dr
Pearland, TX 77584
Phone (713) 442-7200

16659 Southwest Fwy
Sugar Land, TX 77479
Phone 28147946387

17448 Highway 3
Webster, TX 77598
Phone (713) 442-4300

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1129852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481587200000",
    "number": "1699765677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11511 SHADOW CREEK PKWY",
            "address_2": "HR CREDENTIALING SERVICES",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775847298",
            "telephone_number": "713-442-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 AUGUSTA DR",
            "address_2": "TANGLEWOOD CLINIC",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770572209",
            "telephone_number": "713-442-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASTRO",
        "first_name": "KELLY",
        "middle_name": "CAJAHUARINGA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-21",
        "last_updated": "2016-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L1281",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146571803",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146571805",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146571802",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "CAJAHUARINGA",
            "middle_name": "C",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.