Roussel Clement MD PA
Organization Active NPI Internal Medicine Physician · Groves, TX
NPI 1720147762 · NPPES record last updated Jul 21, 2025
Key facts
- NPI
- 1720147762
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- ROUSSEL CLEMENT MD PA
- Practice address
- 6265 39TH St
Groves, TX 77619-4614 - Phone
- (409) 962-4400
- Fax
- (409) 962-4412
- NPI assigned
- Dec 6, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Roussel Clement, MD
- Title
- Practice Owner
- Phone
- (409) 626-2169
Practitioners 5
-
Roussel Clement, MD
-
Tara Fenner, FNP-C
-
My Hien Nguyen, FNP
-
Ashley Walters, NP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D1057557 | Roussel Clement MD | Certificate of waiver | Aug 14, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070118000416 | TX | Part B Supplier - Clinic/Group Practice | 4486655446 |
Receives reassigned benefits from 5 practitioners Practice locations: Beaumont, TX; Groves, TX; Houston, TX |
National Provider Directory
Locations
11850 Bissonnet St
Ste 2
Houston, TX 77099
Phone (409) 962-4400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
6265 39TH St
Groves, TX 77619-4614
Mailing address
6265 39TH St
Groves, TX 77619-4614
Phone (409) 962-4400
Other practice location 1
11850 Bissonnet St Ste 2
Houston, TX 77099-1991
Phone (409) 962-4400
Other providers in Groves, TX
- Lemuel Relford
- Renaissance Hospitals Inc
- Renaissance Hospitals Inc
- Latrissa Rideaux
- Ronald a. Weintraub, MD PA
- Russell N. McDonald
- Ted Sako
- Scott Warren Marks
- Brittany Segura
- Selman Group
All providers in Groves, TX · Internal Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.