Providence Medical and Geriatric Associates, PA

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

M2431 Issued in TX

Legal business name

PROVIDENCE MEDICAL AND GERIATRIC ASSOCIATES, PA

Practice address

110 E Savannah Ave
BLDG C Suite 103
McAllen, TX 78503-1241

Phone

(956) 971-8800

Fax

(956) 971-8804

NPI assigned

Jul 17, 2007

Last updated

Jan 20, 2020By 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

Dr. Olga Maria Olivares-Herrera, MDNPI 1437193836

Title

President

Phone

(956) 971-8800

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 4

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.

• Olga Maria Olivares-Herrera, MD

  • Family Medicine Physician
  • McAllen, TX
  • NPI 1437193836
  Medicare reassignment NPD Authorized official
• Vanessa Gonzales Martinez

  • Family Nurse Practitioner
  • McAllen, TX
  • NPI 1457819104
  Medicare reassignment NPD
• Veronica Resendez, FNP

  • Family Nurse Practitioner
  • McAllen, TX
  • NPI 1316353634
  Medicare reassignment NPD
• John A Lindemann, M.D.

  • Family Medicine Physician
  • Mission, TX
  • NPI 1952374373
  NPD (past)

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

{
    "created_epoch": "1184630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579478400000",
    "number": "1942409198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 306",
            "city": "MCALLEN",
            "state": "TX",
            "postal_code": "785050306",
            "telephone_number": "956-971-8800",
            "fax_number": "956-971-8804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E SAVANNAH AVE",
            "address_2": "BLDG C SUITE 103",
            "city": "MCALLEN",
            "state": "TX",
            "postal_code": "785031241",
            "telephone_number": "956-971-8800",
            "fax_number": "956-971-8804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE MEDICAL AND GERIATRIC ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-17",
        "last_updated": "2020-01-20",
        "certification_date": "2020-01-20",
        "status": "A",
        "authorized_official_last_name": "OLIVARES-HERRERA",
        "authorized_official_first_name": "OLGA",
        "authorized_official_middle_name": "MARIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "956-971-8800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TX",
            "license": "M2431",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0022NP",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "180576401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Professional Medical Tech
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• Promed Preferred TX PLLC
• Prosperity Health Care, LLC
• Proximity Healthcare, PLLC
• Bryan J Prukop, DPM
• Claudia Alejandra Pruneda, DDS
• Michelle Pruneda
• Victoria Pruneda

• General Practice Physician in McAllen, TX
• Providers in McAllen, TX by specialty
• General Practice Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.