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Individual provider Active NPI

Charnell Hollis, NP

  • Family Nurse Practitioner
  • Pasadena, TX
National Provider Identifier
1922883883
Registry record updated Jan 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1096464 Issued in TX
Practice address
4211 Fairmont Pkwy
Pasadena, TX 77504-3324
Phone
(832) 456-8434
NPI assigned
Aug 29, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine Physician 208VP0014X 1096464 TX
Family Nurse Practitioner 363LF0000X 1096464 TX Primary

Addresses

Primary practice location

4211 Fairmont Pkwy
Pasadena, TX 77504-3324

Mailing address

PO Box 35629
Dallas, TX 75235-0629
Phone (214) 424-2200

Other practice location 1

1920 Country Place Pkwy Ste 160
Pearland, TX 77584-2283
Phone (832) 736-2677

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
I20240123004790 TX Practitioner - Nurse Practitioner 1052763216 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4211 Fairmont Pkwy
Pasadena, TX 77504-3324
Phone (832) 456-8434

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1096464TXMDInterventional Pain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Digestive Disease Consultants PLLC CurrentSince Dec 13, 2023 Accepting new patients
Texas Digestive Disease Consultants, PLLC Current Accepting new patients
Texas Digestive Disease Consultants, PLLC CurrentSince Dec 13, 2023 Accepting new patients

Locations

444 FM 1959 Rd
Ste A
Houston, TX 77034
Phone (281) 481-9400

18220 Tomball Pkwy
Ste 290
Houston, TX 77070
Phone (281) 807-6800

601 S Main St
Keller, TX 76248
Phone (817) 741-4347

4211 Fairmont Pkwy
Pasadena, TX 77504
Phone (281) 456-4412

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1693267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1922883883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35629",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752350629",
            "telephone_number": "214-424-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4211 FAIRMONT PKWY",
            "city": "PASADENA",
            "state": "TX",
            "postal_code": "775043324",
            "telephone_number": "832-456-8434"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1920 Country Place Pkwy Ste 160",
            "address_purpose": "LOCATION",
            "city": "Pearland",
            "state": "TX",
            "postal_code": "775842283",
            "country_code": "US",
            "telephone_number": "832-736-2677",
            "fax_number": "832-730-4574",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLLIS",
        "first_name": "CHARNELL",
        "name_prefix": "Miss",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-29",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "TX",
            "license": "1096464",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1096464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, TX

Sources for this page

Verify at the official NPI Registry.