NPIMap

Organization Active NPI

Altus Exceptional Physician Group PLLC

  • Emergency Medicine Physician
  • Orange, TX
National Provider Identifier
1730869207
Registry record updated Jul 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
ALTUS EXCEPTIONAL PHYSICIAN GROUP PLLC
Practice address
1321 N 16TH St
Orange, TX 77630-3609
Phone
(409) 403-3309
NPI assigned
Jul 20, 2023
Last updated
Jul 21, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
TK EMERGENCY PHYSICIANS GROUP PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2023

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

Authorized official

Name
Gale Johnson
Title
VP Revenue Cycle
Phone
(832) 219-3807

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

1321 N 16TH St
Orange, TX 77630-3609

Mailing address

1535 West Loop S
Houston, TX 77027-9512

Other practice location 1

1535 West Loop S
Houston, TX 77027-9512
Phone (832) 219-3833

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240122000381 TX Part B Supplier - Clinic/Group Practice 0042662462 Receives reassigned benefits from 115 practitioners
Practice locations: Houston, TX

National Provider Directory

National Provider Directory
Part of
TK Emer Phys GRP PLLC

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

4755 Eastex Fwy
Beaumont, TX 77706
Phone (409) 924-0055

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 116

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.

View all 116

NPI Registry JSON

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

{
    "created_epoch": "1689811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689897600000",
    "number": "1730869207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1535 WEST LOOP S",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770279512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1321 N 16TH ST",
            "city": "ORANGE",
            "state": "TX",
            "postal_code": "776303609",
            "telephone_number": "409-403-3309"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1535 West Loop S",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770279512",
            "country_code": "US",
            "telephone_number": "832-219-3833",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ALTUS EXCEPTIONAL PHYSICIAN GROUP PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TK EMERGENCY PHYSICIANS GROUP PLLC",
        "enumeration_date": "2023-07-20",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "GALE",
        "authorized_official_title_or_position": "VP REVENUE CYCLE",
        "authorized_official_telephone_number": "832-219-3807"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2023; 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.