Premier General and Colorectal Surgery, PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

N3791 Issued in TX

Legal business name

PREMIER GENERAL AND COLORECTAL SURGERY, PA

Practice address

129 Vision Park Blvd Ste 212
Shenandoah, TX 77384-3024

Phone

(832) 303-2922

Fax

(866) 923-1223

NPI assigned

Aug 2, 2012

Organization subpart

No

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

Authorized official

Name

Cindy Kim

Title

Office Manager

Phone

(832) 303-2922

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• premier general and colorectal surgery PA Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Junuk Kim, MD

  • Surgery Physician
  • Shenandoah, TX
  • NPI 1497917553
  Medicare reassignment NPD
• Matthew Timothy Clark, M.D.

  • Gastroenterology Physician
  • Shenandoah, TX
  • NPI 1497072227
  NPD

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

{
    "created_epoch": "1343865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1760738207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 VISION PARK BLVD STE 212",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773843024",
            "telephone_number": "832-303-2922",
            "fax_number": "866-923-1223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 VISION PARK BLVD STE 212",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773843024",
            "telephone_number": "832-303-2922",
            "fax_number": "866-923-1223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER GENERAL AND COLORECTAL SURGERY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-02",
        "last_updated": "2023-03-07",
        "certification_date": "2022-06-15",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "832-303-2922"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "N3791",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DPS",
            "identifier": "K0169364",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "N3791",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "premier general and colorectal surgery PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Monica Ann Polonyi, PHD, LPC-S
• Natasa Popovic, M.D.
• Angel M Porter, RN
• Lauren Casey Pradilla, PT, DPT
• Sameer Prakash, D.O.
• Premier Genomics LLC
• Premier Pathology Lab, LLC
• Procura Pain and Spine, PLLC
• James Craig Puett, MS, OTR, CHT
• Michelle Pulpan, NP

• Specialist in Shenandoah, TX
• Providers in Shenandoah, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.