Individual provider Active NPI

Mary Kathren Mooney Rouse, MD

  • Pediatrics Physician
  • Houston, TX
National Provider Identifier
1790314664
Registry record updated Apr 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
U1122 Issued in TX
Practice address
6410 Fannin St Ste 500
Houston, TX 77030-3005
Phone
(832) 325-7111
NPI assigned
Apr 3, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X TX
Pediatrics Physician 208000000X U1122 TX Primary

Addresses

Primary practice location

6410 Fannin St Ste 500
Houston, TX 77030-3005

Mailing address

6431 Fannin Street, MSB 3.151
Houston, TX 77030

Other practice location 1

5516 Lockwood Dr
Houston, TX 77026-1919
Phone (713) 497-0000

Other names 1

  • Mary Kathren Mooney Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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 1

Enrollment IDStateProvider typePAC IDDetails
I20231031002364 TX Practitioner - Pediatric Medicine 3779939582 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ut Physicians Pediatrics CurrentSince Jul 11, 2023 Accepting new patients
Ut Physicians CurrentSince Jul 11, 2023 Accepting new patients

Locations

5516 Lockwood Dr
Houston, TX 77026
Phone (713) 497-0000

6431 Fannin St
#3151
Houston, TX 77030
Phone (713) 500-5800

6410 Fannin St
Ste 500
Houston, TX 77030
Phone (713) 500-5714

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": "1585872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680825600000",
    "number": "1790314664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6431 FANNIN STREET, MSB 3.151",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6410 FANNIN ST STE 500",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770303005",
            "telephone_number": "832-325-7111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5516 Lockwood Dr",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770261919",
            "country_code": "US",
            "telephone_number": "713-497-0000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROUSE",
        "first_name": "MARY",
        "middle_name": "KATHREN MOONEY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-03",
        "last_updated": "2023-04-07",
        "certification_date": "2023-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "U1122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "MOONEY",
            "middle_name": "KATHREN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.