Conviva Medical Center Management of Texas, P.A.
NPI 1770988990ActiveOrganization· Internal Medicine· Live Oak, TX
Internal Medicine in Live Oak, Texas, registered in NPPES in October 2014. The authorized official on file is Jessica Bonetti, Associate Director. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1770988990 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Oct 30, 2014 |
| Last updated in NPPES | Jun 21, 2024 |
| Certified by provider | Jun 21, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Internal Medicine Primary | 207R00000X | — | — |
| Family Medicine | 207Q00000X | — | — |
| General Practice | 208D00000X | — | — |
| Clinic/Center, Primary Care | 261QP2300X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (TX) |
|---|
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