Organization Active NPI

Mont Belvieu Providers, PLLC

  • Family Medicine Physician
  • Mont Belvieu, TX
National Provider Identifier
1972296077
Registry record updated Jun 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MONT BELVIEU PROVIDERS, PLLC
Practice address
11303 Eagle Dr
Mont Belvieu, TX 77523-7623
Phone
(281) 385-8111
NPI assigned
Jun 2, 2023
Last updated
Jun 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2025

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

Authorized official

Name
Douglas Chung
Title
Chief Executive Officer
Phone
(281) 385-8111

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Urgent Care Clinic/Center 261QU0200X

Addresses

Primary practice location

11303 Eagle Dr
Mont Belvieu, TX 77523-7623

Mailing address

11303 Eagle Dr
Mont Belvieu, TX 77523-7623
Phone (281) 385-8111

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230816002241 TX Part B Supplier - Clinic/Group Practice 9537521976 Receives reassigned benefits from 14 practitioners
Practice locations: Mont Belvieu, 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
45D2111379Mont Belvieu Providers, PLLC11303 Eagle Drive Ste B, Mont Belvieu, TX 77523Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Locations

1947 Highway 146
Dayton, TX 77535
Phone (303) 919-9126

11303 Eagle Dr
Mont Belvieu, TX 77523
Phone (281) 385-8111

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1685664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748995200000",
    "number": "1972296077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11303 EAGLE DR",
            "city": "MONT BELVIEU",
            "state": "TX",
            "postal_code": "775237623",
            "telephone_number": "281-385-8111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11303 EAGLE DR",
            "city": "MONT BELVIEU",
            "state": "TX",
            "postal_code": "775237623",
            "telephone_number": "281-385-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONT BELVIEU PROVIDERS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-02",
        "last_updated": "2025-06-04",
        "certification_date": "2025-06-04",
        "status": "A",
        "authorized_official_last_name": "CHUNG",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "281-385-8111"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mont Belvieu, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2025; 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.