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CENTRUM MEDICAL GROUP, PLLC
NPI 1376219543
General Practice in Katy, TX

Active since August 18, 2021CLIA 45D2260888 · Waiver
1463 S MASON RD, KATY, TX 77450(305) 266-2929(786) 558-0242 Get Directions Write a Review

NPPES record last updated: January 27, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 27, 2022, Aug 18, 2021 (2 updates tracked since 2021).

About Centrum Medical Group, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CENTRUM MEDICAL GROUP, PLLC (NPI 1376219543) is a healthcare organization registered as a general practice in Katy, Texas and active in the NPI registry since August 2021. The organization holds a CLIA Waiver certificate valid through May 23, 2028 and lists Graciela Vanessa Victorero, Coo, as its authorized official.

NPPES Registry Identity

NPI1376219543
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameCENTRUM MEDICAL GROUP, PLLC
Location Address1463 S MASON RDKaty, TX 77450-4568
Mailing Address9250 Nw 36th St Ste 420Doral, FL 33178-2775 · (305) 266-2929 · Fax (786) 558-0242
Phone(305) 266-2929
Fax(786) 558-0242
Organization SubpartNo
Authorized OfficialGraciela Vanessa VictoreroCoo · (305) 266-2929
Enumeration DateAugust 18, 2021
Last NPPES UpdateJanuary 27, 20222 updates tracked since enumeration
NPPES CertifiedJanuary 27, 2022
✔ NPI 1376219543 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
1463 S MASON RD, Katy, TX 77450
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2260888

Centrum Medical Group, PLLC · Katy, TX
Active · expires May 23, 2028
CLIA Number45D2260888
Laboratory TypePhysician Office
Certificate Effective DateMay 24, 2026
Certificate Expiration DateMay 23, 2028
Laboratory DirectorAyesha Sultana Khan
Laboratory Phone(484) 640-3643
Laboratory LocationCentrum Medical Group, PLLC1463 S Mason Rd, Katy, TX 77450
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. CASSANDRA CHIDIMMA ENEREMADU FNP-C
Nurse Practitioner (Family)
1463 S MASON RD
KATY, TX 77450
Harris County (305) 266-2929
NADIA ESMAEILI PA
Physician Assistant
1463 S MASON RD
KATY, TX 77450
Harris County (281) 771-1166
DIABETES REVERSAL OF AMERICA, LLC
Clinic/Center (Infusion Therapy)
1463 S MASON RD
KATY, TX 77450
Harris County (281) 808-7381
CENTRUM MEDICAL HOLDINGS OF TEXAS, LLC
General Practice
1463 S MASON RD
KATY, TX 77450
Harris County (305) 266-2929

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Centrum Medical Group, PLLC's NPI number?

The NPI number for Centrum Medical Group, PLLC is 1376219543. It was assigned to this organization in the NPPES registry on August 18, 2021.

Where is Centrum Medical Group, PLLC located?

Centrum Medical Group, PLLC is located at 1463 S Mason Rd, Katy, TX 77450. The listed phone number is (305) 266-2929.

What is Centrum Medical Group, PLLC's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Does Centrum Medical Group, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2260888) is associated with this NPI, valid through May 23, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Centrum Medical Group, PLLC accept?

Health plans from Ambetter Health, Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and Ambetter from Superior HealthPlan and 2 other insurers list Centrum Medical Group, PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Centrum Medical Group, PLLC was last updated on January 27, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.