Clear Lake Neuro Diagnostic Clinic PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

J9590 Issued in TX

Legal business name

CLEAR LAKE NEURO DIAGNOSTIC CLINIC PLLC

Practice address

380 E Medical Center Blvd
Webster, TX 77598-4321

Phone

(281) 332-6949

Fax

(281) 332-6965

NPI assigned

Feb 6, 2007

Organization subpart

No

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

Authorized official

Name

Willa Marie Lebas, M.D.NPI 1144215815

Title

Officer

Phone

(281) 332-6949

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 3

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

• Willa Marie Lebas, M.D.

  • Specialist
  • Webster, TX
  • NPI 1144215815
  Medicare reassignment NPD Authorized official
• Mavis D Fujii, M.D.

  • Neurology Physician
  • Houston, TX
  • NPI 1013099399
  NPD (past)
• Rebecca A Grimaldo, R.N., FNP-C

  • Family Nurse Practitioner
  • Houston, TX
  • NPI 1457433757
  NPD (past)

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299196800000",
    "number": "1972642940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 E MEDICAL CENTER BLVD",
            "city": "WEBSTER",
            "state": "TX",
            "postal_code": "775984321",
            "telephone_number": "281-332-6949",
            "fax_number": "281-332-6965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 E MEDICAL CENTER BLVD",
            "city": "WEBSTER",
            "state": "TX",
            "postal_code": "775984321",
            "telephone_number": "281-332-6949",
            "fax_number": "281-332-6965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEAR LAKE NEURO DIAGNOSTIC CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2011-03-04",
        "status": "A",
        "authorized_official_last_name": "LEBAS",
        "authorized_official_first_name": "WILLA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "281-332-6949",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "J9590",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE, RAILROAD",
            "identifier": "DE5776",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clear Lake Inpatient Care PA
• Clear Lake Institute for Rehabilitation LLC
• Clear Lake Integrated Health Care
• Clear Lake Internal Medicine Care PA
• Clear Lake Laboratory LLC
• Clear Lake OBGYN, PLLC
• Clear Lake Oncology PLLC
• Clear Lake Ophthalmology Clinic PLLC
• Clear Lake Oral and Maxillofacial Surgeyy, PLLC
• Clear Lake Pediatric Clinic, P.a.

• Specialist in Webster, TX
• Providers in Webster, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2011; 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.