NPIMap

Organization Active NPI

Wellspring CV, LLC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Houston, TX
National Provider Identifier
1801409529
Registry record updated Aug 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
WELLSPRING CV, LLC
Practice address
5373 W Alabama Street
Ste 204
Houston, TX 77056
Phone
(713) 714-4040
Fax
(713) 588-1850
NPI assigned
Aug 24, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2021

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

Authorized official

Name
Dr. Cornelius Davis, MD
Title
Owner
Phone
(713) 714-4040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208G00000X Primary

Addresses

Primary practice location

5373 W Alabama Street
Ste 204
Houston, TX 77056

Mailing address

PO Box 2868
Bellaire, TX 77402-2868
Phone (713) 714-4040

Other identifiers 1

IdentifierTypeStateIssuer
165376801MedicaidTX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1598227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628726400000",
    "number": "1801409529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2868",
            "city": "BELLAIRE",
            "state": "TX",
            "postal_code": "774022868",
            "telephone_number": "713-714-4040",
            "fax_number": "713-588-1850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5373 W ALABAMA STREET",
            "address_2": "STE 204",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77056",
            "telephone_number": "713-714-4040",
            "fax_number": "713-588-1850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPRING CV, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-24",
        "last_updated": "2021-08-12",
        "certification_date": "2021-08-12",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "CORNELIUS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "713-714-4040",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165376801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.