Conviva Medical Center Management of Texas, P.a.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

CONVIVA MEDICAL CENTER MANAGEMENT OF TEXAS, P.A.

Practice address

12602 Toepperwein Rd Ste 100
Live Oak, TX 78233-3204

Phone

(210) 654-0030

Fax

(855) 278-4550

NPI assigned

Oct 30, 2014

Last updated

Jun 21, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jessica Bonetti

Title

Associate Director

Phone

(786) 507-8556

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Centerwell Senior Primary Care (SC) PC

  dba CenterWell Senior Primary Care -Anderson

  • Internal Medicine Physician
  • Anderson, SC
  • NPI 1710341144

  8729302278

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 193

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.

• Yvonne Kenyu Agunsoye, FNP-BC

  • Family Nurse Practitioner
  • Corpus Christi, TX
  • NPI 1518584382
  Medicare reassignment Care Compare group NPD
• Akinremi Ayodeji Akinwale, MD

  • Internal Medicine Physician
  • San Antonio, TX
  • NPI 1215022694
  Medicare reassignment Care Compare group NPD
• Christopher T Alcorta, MD

  • Family Medicine Physician
  • San Antonio, TX
  • NPI 1225611932
  Medicare reassignment Care Compare group NPD
• Laura S. Allen, M.D.

  • Family Medicine Physician
  • Jourdanton, TX
  • NPI 1386762714
  Medicare reassignment Care Compare group NPD
• Fahd Alnori M Almohid, M.D.

  • Internal Medicine Physician
  • Live Oak, TX
  • NPI 1346669587
  Medicare reassignment Care Compare group NPD
• Yvette Valerio Alvarez, D.O.

  • Family Medicine Physician
  • Rockport, TX
  • NPI 1528328309
  Medicare reassignment Care Compare group NPD
• Joshua Steven Anderson, DNP, APRN, FNP-BC

  • Family Nurse Practitioner
  • Corpus Christi, TX
  • NPI 1548734817
  Medicare reassignment Care Compare group NPD
• Kindal Lee Andrews, APRN

  • Family Nurse Practitioner
  • Corpus Christi, TX
  • NPI 1083067631
  Medicare reassignment Care Compare group NPD
• Mario Angeles Jr., MD

  • Family Medicine Physician
  • San Antonio, TX
  • NPI 1659990513
  Medicare reassignment Care Compare group NPD
• Adriana E Arocha, M.D.

  • Family Medicine Physician
  • San Antonio, TX
  • NPI 1659726826
  Medicare reassignment Care Compare group NPD
• Vivian M Ayoub, M.D.

  • Internal Medicine Physician
  • San Antonio, TX
  • NPI 1215971882
  Medicare reassignment Care Compare group NPD
• Jacqueline Bliven

  • Nurse Practitioner
  • Corpus Christi, TX
  • NPI 1962119990
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1414627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718928000000",
    "number": "1770988990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263168",
            "telephone_number": "305-500-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12602 TOEPPERWEIN RD STE 100",
            "city": "LIVE OAK",
            "state": "TX",
            "postal_code": "782333204",
            "telephone_number": "210-654-0030",
            "fax_number": "855-278-4550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12602 Toepperwein Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Live Oak",
            "state": "TX",
            "postal_code": "782333204",
            "country_code": "US",
            "telephone_number": "210-654-0030",
            "fax_number": "855-278-4550",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CONVIVA MEDICAL CENTER MANAGEMENT OF TEXAS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-30",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "status": "A",
        "authorized_official_last_name": "BONETTI",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR",
        "authorized_official_telephone_number": "786-507-8556"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "350315301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiffany Jailene Colon Rodriguez, MS
• Owen Comeau
• Comfort Home Care Solutions LLC
• Concentra Primary Care PA (Allied Institute of Medicine)
• Consultants in Pain Medicine PLLC
• Rebecca Laura Cook, DO
• Sarah R Cook, P.T.
• Carnell Cooper, M.D.
• Mathilde Athenais Leontine Coquillaud-Salomon
• Sasha Cora, DC

• Internal Medicine Physician in Live Oak, TX
• Providers in Live Oak, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.