Organization Active NPI

David P Ellent PLLC

  • Clinical Medical Laboratory
  • Kingwood, TX
National Provider Identifier
1891348959
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
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

Updated by the provider on Apr 26, 2023

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)CodeLicenseStatePrimary
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 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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 NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2080766Genesis Medical Group22001 Northpark Dr Suite 220, Kingwood, TX 77339AccreditationMar 15, 2028

National Provider Directory

National Provider Directory

Locations

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.

View all 117

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.

Verify at the official NPI Registry.