Organization Active NPI

KPS Ventures PLLC

  • Plastic Surgery Physician
  • Dallas, TX
National Provider Identifier
1013809219
Registry record updated Jul 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
Legal business name
KPS VENTURES PLLC
Practice address
12228 N Central Expy Ste 360
Dallas, TX 75243-3779
Phone
(214) 550-0033
NPI assigned
Jul 21, 2025
Last updated
Jul 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2025

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

Authorized official

Name
Kelly Schultz, MDNPI 1508328519
Title
Owner
Phone
(214) 550-0033

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X NU Primary

Addresses

Primary practice location

12228 N Central Expy Ste 360
Dallas, TX 75243-3779

Mailing address

904 Aspen Ridge Dr
Southlake, TX 76092-3826
Phone (214) 550-0033

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250805002801 TX Part B Supplier - Clinic/Group Practice 9133637606 Receives reassigned benefits from 1 practitioner
Practice locations: Dallas, TX

National Provider Directory

National Provider Directory

Locations

12228 N Central Expy
Ste 360
Dallas, TX 75243
Phone (214) 550-0033

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1753056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753056000000",
    "number": "1013809219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 ASPEN RIDGE DR",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760923826",
            "telephone_number": "214-550-0033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12228 N CENTRAL EXPY STE 360",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752433779",
            "telephone_number": "214-550-0033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KPS VENTURES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-21",
        "last_updated": "2025-07-21",
        "certification_date": "2025-07-21",
        "status": "A",
        "authorized_official_last_name": "SCHULTZ",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-550-0033",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2025; 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.