Organization Active NPI

Conroe-Woodlands Gastroenterology, P.a.

  • Gastroenterology Physician
  • Conroe, TX
National Provider Identifier
1962539155
Registry record updated Aug 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
CONROE-WOODLANDS GASTROENTEROLOGY, P.A.
Practice address
1020 Riverwood CT Ste 300
Conroe, TX 77304-2974
Phone
(936) 760-1900
Fax
(936) 441-1907
NPI assigned
Feb 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2023

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

Authorized official

Name
Dr. Stephen Michael Kelly, MDNPI 1245367663
Title
President
Phone
(936) 760-1900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

1020 Riverwood CT Ste 300
Conroe, TX 77304-2974

Mailing address

1020 Riverwood CT Ste 300
Conroe, TX 77304-2974
Phone (936) 760-1900

Other identifiers 1

IdentifierTypeStateIssuer
1729485MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040724000123 TX Part B Supplier - Clinic/Group Practice 7618957028 Receives reassigned benefits from 2 practitioners
Practice locations: Conroe, TX; Shenandoah, TX

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
45D0943120Conroe-Woodlands Gastroenterology1020 Riverwood Court Suite 300, Conroe, TX 77304Certificate of waiverMar 12, 2027
45D2327769Conroe-Woodlands Gastroenterology, PA1020 Riverwood CT # 300, Conroe, TX 77304RegistrationJul 28, 2027

National Provider Directory

National Provider Directory

Locations

1020 Riverwood Ct
Ste 300
Conroe, TX 77304
Phone (936) 760-1900

1501 River Pointe Dr
Ste 260
Conroe, TX 77304
Phone (936) 494-3003

1501 River Pointe Dr
Ste 240
Conroe, TX 77304
Phone (936) 494-3003

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693267200000",
    "number": "1962539155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 RIVERWOOD CT STE 300",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773042974",
            "telephone_number": "936-760-1900",
            "fax_number": "936-441-1907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 RIVERWOOD CT STE 300",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773042974",
            "telephone_number": "936-760-1900",
            "fax_number": "936-441-1907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONROE-WOODLANDS GASTROENTEROLOGY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-29",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "936-760-1900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1729485",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 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.