Outreach Diagnostic Clinic

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

F0083 Issued in TX

Legal business name

OUTREACH DIAGNOSTIC CLINIC

Doing business as

Wills Diagnostic Clinic

Practice address

2000 Crawford St
Suite 900
Houston, TX 77002-9011

Phone

(713) 651-0870

NPI assigned

Jul 23, 2008

Last updated

Sep 18, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Omar Kiggundu

Title

Chief Operating Officer

Phone

(713) 532-7311

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Wills Diagnostic Clinic Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

Practitioners 3

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.

• Michael Philip Sorensen, O.D

  • Optometrist
  • Kingwood, TX
  • NPI 1891863551
  NPD (past)
• Enyibuaku Rita Uzoaga, MD

  • Family Medicine Physician
  • Houston, TX
  • NPI 1245246925
  NPD (past)
• Yusuf A Mosuro, MD

  • Pain Medicine (Anesthesiology) Physician
  • Middleburg, FL
  • NPI 1881760072
  NPD (past)

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

{
    "created_epoch": "1216771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379462400000",
    "number": "1902061575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5120 WOODWAY DRIVE",
            "address_2": "SUITE 7012",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770561791",
            "telephone_number": "713-532-7311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 CRAWFORD ST",
            "address_2": "SUITE 900",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770029011",
            "telephone_number": "713-651-0870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTREACH DIAGNOSTIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-23",
        "last_updated": "2013-09-18",
        "status": "A",
        "authorized_official_last_name": "KIGGUNDU",
        "authorized_official_first_name": "OMAR",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "713-532-7311",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "M3453",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "F0083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197746401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wills Diagnostic Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Outpatient Recovery Center, LLC (Anew Recovery Outpatient Center)
• Outpatient Special Surgery Partners LTD (Special Surgery of Houston)
• Outpatient Women's and Children's Surgery Center, LTD (Fannin Surgicare)
• Beverly Ann Outram, SURGICAL ASSISTANT
• Outreach Assisted Living Facility 2
• Outreach for the Aged Inc. (Dba)
• Outreach Health Community Care Services LP (Outreach Health)
• Outreach Health Community Care Services, L.P. (Outreach Health Services)
• Outreach Health Community Care Services, L.P. (Outreach Health Services)
• Outreach Health Community Care Services, L.P. (Outreach Home Care)

• Internal Medicine Physician in Houston, TX
• Providers in Houston, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.