Organization Active NPI

Cornelia L Agent MD PA

  • Internal Medicine Physician
  • Alvin, TX
National Provider Identifier
1831473354
Registry record updated Oct 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
F9123 Issued in TX
Legal business name
CORNELIA L AGENT MD PA
Practice address
215 W Blackstone LN
Alvin, TX 77511-3407
Phone
(281) 331-5253
Fax
(281) 585-4074
NPI assigned
Oct 3, 2011
Last updated
Oct 3, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2011

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

Authorized official

Name
Cornelia L Agent, MDNPI 1457452526
Title
Owner
Phone
(281) 331-5253

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X F9123 TX Primary

Addresses

Primary practice location

215 W Blackstone LN
Alvin, TX 77511-3407

Mailing address

215 W Blackstone LN
Alvin, TX 77511-3407
Phone (281) 331-5253

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120531000584 TX Part B Supplier - Clinic/Group Practice 8820251887 Receives reassigned benefits from 1 practitioner
Practice locations: Alvin, TX; La Marque, TX; Texas City, TX

National Provider Directory

National Provider Directory

Locations

215 W Blackstone Ln
Alvin, TX 77511
Phone (281) 331-5253

3820 Mustang Rd
Laurel CT
Alvin, TX 77511
Phone (281) 824-0070

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1317600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317600000000",
    "number": "1831473354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 W BLACKSTONE LN",
            "city": "ALVIN",
            "state": "TX",
            "postal_code": "775113407",
            "telephone_number": "281-331-5253",
            "fax_number": "281-585-4074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 W BLACKSTONE LN",
            "city": "ALVIN",
            "state": "TX",
            "postal_code": "775113407",
            "telephone_number": "281-331-5253",
            "fax_number": "281-585-4074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNELIA L AGENT MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-03",
        "last_updated": "2011-10-03",
        "status": "A",
        "authorized_official_last_name": "AGENT",
        "authorized_official_first_name": "CORNELIA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "281-331-5253",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "F9123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alvin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2011; 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.