Individual provider Active NPI

Andrew Sumarsono, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Houston, TX
National Provider Identifier
1750822094
Registry record updated Jun 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
R9447 Issued in TX
Practice address
20405 State Highway 249 Ste 325
Houston, TX 77070-2893
Phone
(866) 849-0692
Fax
(888) 973-8821
NPI assigned
Mar 20, 2017
Last updated
Jun 11, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2026

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

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Geriatric Medicine (Internal Medicine) Physician 207RG0300X ME171302 FL
Geriatric Medicine (Internal Medicine) Physician 207RG0300X MD484882 PA
Geriatric Medicine (Internal Medicine) Physician 207RG0300X MD.48055 AL
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 35C.001260 OH
Geriatric Medicine (Internal Medicine) Physician 207RG0300X MD61609756 WA
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 2024049377 MO
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 2024-00918 NC
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 102421 GA
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 036.168294 IL
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 93618 SC
Geriatric Medicine (Internal Medicine) Physician 207RG0300X CDR.0003652 CO
Geriatric Medicine (Internal Medicine) Physician 207RG0300X R9447 TX Primary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 72555 AZ
Hospitalist Physician 208M00000X R9447 TX

Addresses

Primary practice location

20405 State Highway 249 Ste 325
Houston, TX 77070-2893

Mailing address

PO Box 211699
Eagan, MN 55121-3699
Phone (866) 849-0692

Other practice location 1

1055 Howell Mill Rd NW Fl 8
Atlanta, GA 30318-5557
Phone (866) 849-0692

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, CO, PA, IL, AZ, AL, NC, MS, WA9 enrollments
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 9

Enrollment IDStateProvider typePAC IDDetails
I20200908000738 TX Practitioner - Internal Medicine 3577980564 Reassigns benefits to 2 organizations
I20240510002191 CO Practitioner - Internal Medicine 3577980564 Reassigns benefits to 1 organization
I20240513002173 PA Practitioner - Internal Medicine 3577980564 Reassigns benefits to 1 organization
I20240516000430 IL Practitioner - Internal Medicine 3577980564 Reassigns benefits to 1 organization
I20240516004239 AZ Practitioner - Internal Medicine 3577980564 Reassigns benefits to 1 organization
I20240517003329 AL Practitioner - Internal Medicine 3577980564 Reassigns benefits to 1 organization
I20240523004030 NC Practitioner - Internal Medicine 3577980564 Reassigns benefits to 1 organization
I20241001002289 MS Practitioner - Geriatric Medicine 3577980564 Reassigns benefits to 1 organization
I20241211001280 WA Practitioner - Geriatric Medicine 3577980564 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD.48055ALMDGeriatric Medicine (Internal Medicine) Physician
ME171302FLMDGeriatric Medicine (Internal Medicine) Physician
102421GAMDGeriatric Medicine (Internal Medicine) Physician
036.168294ILMDGeriatric Medicine (Internal Medicine) Physician
2024049377MOMDGeriatric Medicine (Internal Medicine) Physician
MD484882PAMDGeriatric Medicine (Internal Medicine) Physician
93618SCMDGeriatric Medicine (Internal Medicine) Physician
MD61609756WAMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Devoted Medical PA PC CurrentSince May 9, 2024 Accepting new patients
Devoted Medical Group Professional Corporation CurrentSince Apr 25, 2024 Accepting new patients
Devoted Medical NC PC CurrentSince May 9, 2024 Accepting new patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Jul 1, 2020 Accepting new patients
Devoted Medical PC CurrentSince Apr 26, 2024 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients
Devoted Medical Group of Texas Inc CurrentSince Apr 25, 2024 Accepting new patients
University of Texas Southwestern Medical Center at Dallas CurrentSince Jul 1, 2020 Accepting new patients

Locations

16435 N Scottsdale Rd
Ste 285
Scottsdale, AZ 85254
Phone (520) 346-4431

200 S Wacker Dr
Fl 31
Chicago, IL 60606
Phone (313) 716-0029

221 Crescent St
Ste 202
Waltham, MA 02453
Phone (617) 958-1611

232 Market St
Jackson, MS 39232
Phone (588) 498-6767

100 S Juniper St
Fl 3
Philadelphia, PA 19107
Phone (267) 999-9534

1801 Inwood Rd
Fl Seventh
Dallas, TX 75235

1201 Fannin St
Ste 262
Houston, TX 77002
Phone (346) 768-8399

20405 State Highway 249
Ste 325
Houston, TX 77070
Phone (713) 597-5114

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

1220 Main St
Ste 400
Vancouver, WA 98660
Phone (360) 230-8557

Organizations & group practices 9

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

NPI Registry JSON

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

{
    "created_epoch": "1489968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781136000000",
    "number": "1750822094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 211699",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551213699",
            "telephone_number": "866-849-0692",
            "fax_number": "888-973-8821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20405 STATE HIGHWAY 249 STE 325",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770702893",
            "telephone_number": "866-849-0692",
            "fax_number": "888-973-8821"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1055 Howell Mill Rd NW Fl 8",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303185557",
            "country_code": "US",
            "telephone_number": "866-849-0692",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUMARSONO",
        "first_name": "ANDREW",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-20",
        "last_updated": "2026-06-11",
        "certification_date": "2026-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "FL",
            "license": "ME171302",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "PA",
            "license": "MD484882",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "AL",
            "license": "MD.48055",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "OH",
            "license": "35C.001260",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "WA",
            "license": "MD61609756",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MO",
            "license": "2024049377",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NC",
            "license": "2024-00918",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "GA",
            "license": "102421",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "IL",
            "license": "036.168294",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "SC",
            "license": "93618",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CO",
            "license": "CDR.0003652",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "TX",
            "license": "R9447",
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "AZ",
            "license": "72555",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TX",
            "license": "R9447",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.