Active NPI
David P Ellent PLLC
- Clinical Medical Laboratory
- Kingwood, TX
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- Legal business name
- DAVID P ELLENT PLLC
- Practice address
- 22001 Northpark Dr Ste 220
Kingwood, TX 77339-3810 - Phone
- (281) 319-8399
- NPI assigned
- Jul 18, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ivan Tarasenko
- Title
- Coo
- Phone
- (281) 908-0686
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | Primary |
Addresses
Primary practice location
22001 Northpark Dr Ste 220
Kingwood, TX 77339-3810
Mailing address
22001 Northpark Dr Ste 220
Kingwood, TX 77339-3811
Phone (281) 908-0686
Other names 1
- Genesis Medical Group
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230609001589 | TX | Part B Supplier - Independent Clinical Laboratory | 7012290885 | Practice locations: Kingwood, TX |
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D2080766 | Genesis Medical Group | Accreditation | Mar 15, 2028 |
National Provider Directory
National Provider DirectoryLocations
1626 W Baker Rd
Baytown, TX 77521
Phone (281) 628-7300
108 N Main St
Ste 1
Dayton, TX 77535
9525 Katy Fwy
Houston, TX 77024
800 Peakwood Dr
Ste 3A
Houston, TX 77090
Phone (281) 587-8777
643 Ih 45 S
#A
Huntsville, TX 77340
22751 Professional Dr
Ste 140
Kingwood, TX 77339
Phone (281) 319-8380
22001 Northpark Dr
Ste 220
Kingwood, TX 77339
Phone (281) 319-8399
22751 Professional Dr
Ste 100
Kingwood, TX 77339
Phone (281) 319-8333
350 Kingwood Medical Dr
Ste 250
Kingwood, TX 77339
790 Generations Dr
Ste 500
New Braunfels, TX 78130
Phone (512) 994-4159
790 Generations Dr
Ste 450
New Braunfels, TX 78130
2255 E Mossy Oaks Rd
Ste 500
Spring, TX 77389
Phone (832) 232-5658
24727 State Highway 249
Ste 120
Tomball, TX 77375
24721 State Highway 249
Tomball, TX 77375
Phone (281) 205-3681
Practitioners & affiliated clinicians
Practitioners 117
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563408000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1682467200000",
"number": "1891348959",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22001 NORTHPARK DR STE 220",
"city": "KINGWOOD",
"state": "TX",
"postal_code": "773393811",
"telephone_number": "281-908-0686"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22001 NORTHPARK DR STE 220",
"city": "KINGWOOD",
"state": "TX",
"postal_code": "773393810",
"telephone_number": "281-319-8399"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DAVID P ELLENT PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-07-18",
"last_updated": "2023-04-26",
"certification_date": "2023-04-26",
"status": "A",
"authorized_official_last_name": "TARASENKO",
"authorized_official_first_name": "IVAN",
"authorized_official_title_or_position": "COO",
"authorized_official_telephone_number": "281-908-0686"
},
"taxonomies": [
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Genesis Medical Group",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Kingwood, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2023; 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.