NPIMap

Individual provider Active NPI

Shahin Tavackoli, M.D.

  • Cardiovascular Disease Physician
  • Houston, TX
National Provider Identifier
1902024987
Registry record updated Sep 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
K8986 Issued in TX
Practice address
925 Gessner Rd
Suite 630
Houston, TX 77024
Phone
(713) 465-3535
Fax
(713) 465-9735
NPI assigned
Apr 23, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X K8986 TX Primary

Addresses

Primary practice location

925 Gessner Rd
Suite 630
Houston, TX 77024

Mailing address

925 Gessner Rd
Suite 630
Houston, TX 77024
Phone (713) 465-3535

Other identifiers 1

IdentifierTypeStateIssuer
170041101MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040716000869 TX Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Emergency Medicine 8527047117 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
University of Texas Medical Branch at Galveston, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Memorial Hermann Medical GroupGroup PAC ID 7012008360, 760 clinicians

Practice addresses (Care Compare)

1140 Business Ctr Dr
Suite 500
Houston, TX 77043-2744
Phone (713) 465-3535

915 Gessner Rd
Suite 100
Houston, TX 77024-2537
Phone (713) 242-2222

921 Gessner Rd
Houston, TX 77024-2501

925 Gessner Rd
Suite 400
Houston, TX 77024-2547
Phone (713) 467-0605

925 Gessner Rd
Suite 630
Houston, TX 77024-2553
Phone (713) 465-3535

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hermann Medical Group Cardiovascular Disease CurrentSince Apr 5, 2019 Accepting new patients
Oncology Consultants, P. a. Past Accepting new patients
Utmb Faculty Group Practice Past Accepting new patients
Oncology Consultants, P. a. Past Accepting new patients

Locations

1505 E Winding Way Dr
Ste 200
Friendswood, TX 77546
Phone (713) 366-7800

915 Gessner Rd
Ste 100
Houston, TX 77024
Phone (713) 242-2222

1140 Business Center Dr
Ste 500
Houston, TX 77043
Phone (713) 407-3000

925 Gessner Rd
Ste 630
Houston, TX 77024
Phone (713) 465-3535

1801 North Loop W
Ste 30
Houston, TX 77008
Phone (713) 802-9781

3203 Broadway St
Pearland, TX 77581
Phone (281) 485-8876

Interoperability endpoints

  • Direct secure messaging: stavackoli66887@memorialhermann.direct-ci.com

Organizations & group practices 4

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.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726790400000",
    "number": "1902024987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 GESSNER RD",
            "address_2": "SUITE 630",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77024",
            "telephone_number": "713-465-3535",
            "fax_number": "713-465-9735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 GESSNER RD",
            "address_2": "SUITE 630",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77024",
            "telephone_number": "713-465-3535",
            "fax_number": "713-465-9735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVACKOLI",
        "first_name": "SHAHIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-23",
        "last_updated": "2024-09-20",
        "certification_date": "2024-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TX",
            "license": "K8986",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "170041101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.