Individual provider Active NPI

Yassmin Mahmoodpour Soudjani

  • Physician Assistant
  • Houston, TX
National Provider Identifier
1780394643
Registry record updated Nov 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA16457 Issued in TX
Practice address
19002 Park Row Ste 105
Houston, TX 77084-7060
Phone
(346) 251-5901
NPI assigned
Dec 1, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA16457 TX Primary

Addresses

Primary practice location

19002 Park Row Ste 105
Houston, TX 77084-7060

Mailing address

14031 Pinerock LN
Houston, TX 77079-3222
Phone (832) 758-7135

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PA16457TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Fulshear Medical Associates PLLC CurrentSince Nov 12, 2023 Accepting new patients
Fulshear Family Health Consultants CurrentSince Nov 12, 2023 Accepting new patients

Locations

19002 Park Row
Ste 105
Houston, TX 77084
Phone (345) 251-5901

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DBGHAD

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1669852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699315200000",
    "number": "1780394643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14031 PINEROCK LN",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770793222",
            "telephone_number": "832-758-7135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19002 PARK ROW STE 105",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770847060",
            "telephone_number": "346-251-5901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHMOODPOUR SOUDJANI",
        "first_name": "YASSMIN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-01",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA16457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.