Organization Active NPI

Conviva Medical Center Management of Texas, PLLC

Doing business as Conviva Care Center

  • Family Medicine Physician
  • San Antonio, TX
National Provider Identifier
1972842664
Registry record updated May 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CONVIVA MEDICAL CENTER MANAGEMENT OF TEXAS, PLLC
Doing business as
Conviva Care Center
Practice address
18414 US Highway 281 N Ste 104
San Antonio, TX 78259
Phone
(210) 495-0222
Fax
(210) 495-5914
NPI assigned
Jan 31, 2013
Organization subpart
Yes
Parent organization
CONVIVA MEDICAL CENTER MANAGEMENT OF TEXAS, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 20, 2025

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

Authorized official

Name
Gioany Bacon-Williams
Title
Director, Provider Contracting
Phone
(210) 608-2110

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X

Addresses

Primary practice location

18414 US Highway 281 N Ste 104
San Antonio, TX 78259

Mailing address

6101 Blue Lagoon Dr Ste 400
Miami, FL 33126-2051
Phone (305) 500-2000

Other practice location 1

4254 S Alameda St
Corpus Christi, TX 78412-2469
Phone (361) 853-4191

Other practice location 2

9727 Poteet Jourdanton Fwy Ste 108
San Antonio, TX 78211-4575
Phone (210) 923-4372

Other practice location 3

1314 Guadalupe St Ste 105
San Antonio, TX 78207-5582
Phone (210) 225-4810

Other practice location 4

1209 Highway 35 N
Rockport, TX 78382-3117
Phone (361) 729-9811

Other practice location 5

10435 Vista Del Sol Dr
El Paso, TX 79925-7920
Phone (915) 591-6229

Other practice location 6

917 S Port Ave
Corpus Christi, TX 78405-2301
Phone (361) 887-0584

Other practice location 7

1211B E Cliff Dr
El Paso, TX 79902-4734
Phone (915) 591-6226

Other practice location 8

1911 Rogers Rd
San Antonio, TX 78251-4614
Phone (210) 523-9933

Other names 1

  • Conviva Care Center Doing business as

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
45D0502882Conviva Medical Center Management of Texas PA4254 S Alameda Street, Corpus Christi, TX 78412Certificate of waiverMay 10, 2028
45D0509418Conviva Medical Center Management of10435 Vista del Sol Dr, El Paso, TX 79925Certificate of waiverMay 10, 2028
45D1023179Conviva Medical Center Management of Texas PA1911 Rogers Road, San Antonio, TX 78251Certificate of waiverMar 8, 2028
45D2062228Conviva Medical Center Management of Texas PA18414 US Hwy 281 North Suite 104, San Antonio, TX 78259Certificate of waiverJul 11, 2027
45D2070575Conviva Medical Center Management of Texas, PA917 South Port Avenue, Corpus Christi, TX 78405Certificate of waiverDec 18, 2027

National Provider Directory

National Provider Directory
Part of
McCi of TX Primary Care GRP

Locations

10435 Vista del Sol Dr
El Paso, TX 79925
Phone (915) 591-6227

9727 Poteet Jourdanton Fwy
San Antonio, TX 78211
Phone (210) 881-0643

9727 Poteet Jourdanton Fwy
Ste 108
San Antonio, TX 78211
Phone (210) 733-5072

7430 Barlite Blvd
San Antonio, TX 78224
Phone (210) 923-5581

9727 Poteet Jourdanton Fwy
Ste 1
San Antonio, TX 78211

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1359590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747699200000",
    "number": "1972842664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 400",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331262051",
            "telephone_number": "305-500-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18414 US HIGHWAY 281 N STE 104",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78259",
            "telephone_number": "210-495-0222",
            "fax_number": "210-495-5914"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4254 S Alameda St",
            "address_purpose": "LOCATION",
            "city": "Corpus Christi",
            "state": "TX",
            "postal_code": "784122469",
            "country_code": "US",
            "telephone_number": "361-853-4191",
            "fax_number": "361-853-8768",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9727 Poteet Jourdanton Fwy Ste 108",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782114575",
            "country_code": "US",
            "telephone_number": "210-923-4372",
            "fax_number": "210-923-5581",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1314 Guadalupe St Ste 105",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782075582",
            "country_code": "US",
            "telephone_number": "210-225-4810",
            "fax_number": "210-686-3835",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1209 Highway 35 N",
            "address_purpose": "LOCATION",
            "city": "Rockport",
            "state": "TX",
            "postal_code": "783823117",
            "country_code": "US",
            "telephone_number": "361-729-9811",
            "fax_number": "361-729-9819",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10435 Vista Del Sol Dr",
            "address_purpose": "LOCATION",
            "city": "El Paso",
            "state": "TX",
            "postal_code": "799257920",
            "country_code": "US",
            "telephone_number": "915-591-6229",
            "fax_number": "915-206-6385",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "917 S Port Ave",
            "address_purpose": "LOCATION",
            "city": "Corpus Christi",
            "state": "TX",
            "postal_code": "784052301",
            "country_code": "US",
            "telephone_number": "361-887-0584",
            "fax_number": "361-887-0586",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1211B E Cliff Dr",
            "address_purpose": "LOCATION",
            "city": "El Paso",
            "state": "TX",
            "postal_code": "799024734",
            "country_code": "US",
            "telephone_number": "915-591-6226",
            "fax_number": "915-308-9433",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1911 Rogers Rd",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782514614",
            "country_code": "US",
            "telephone_number": "210-523-9933",
            "fax_number": "210-647-0242",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CONVIVA MEDICAL CENTER MANAGEMENT OF TEXAS, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CONVIVA MEDICAL CENTER MANAGEMENT OF TEXAS, PLLC",
        "enumeration_date": "2013-01-31",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-20",
        "status": "A",
        "authorized_official_last_name": "BACON-WILLIAMS",
        "authorized_official_first_name": "GIOANY",
        "authorized_official_title_or_position": "DIRECTOR, PROVIDER CONTRACTING",
        "authorized_official_telephone_number": "210-608-2110"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Conviva Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.