Individual provider Active NPI

Kelly Ann Waldvogel, NP

  • Family Nurse Practitioner
  • Houston, TX
National Provider Identifier
1023668803
Registry record updated Aug 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP145502 Issued in TX
Practice address
1515 Holcombe Blvd
Houston, TX 77030-4000
Phone
(713) 792-6161
NPI assigned
Sep 13, 2019
Last updated
Aug 8, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP145502 TX Primary

Addresses

Primary practice location

1515 Holcombe Blvd
Houston, TX 77030-4000

Mailing address

PO Box 4439
Houston, TX 77210-4439
Phone (713) 792-2991

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200420002930 TX Practitioner - Nurse Practitioner 8820428592 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians Referral ServiceGroup PAC ID 7911801410, 2,728 clinicians
Doctors Express of the Beaumont Area PAGroup PAC ID 5698816882, 211 clinicians

Practice addresses (Care Compare)

1515 Holcombe Blvd
Houston, TX 77030-4000
Phone (713) 792-2121

3195 Dowlen Rd
Suite 105
Beaumont, TX 77706-7272
Phone (409) 860-1888

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.29 of 100Reported as group
Quality
70.82
Promoting interoperability
100
Improvement activities
40
Cost
67.65

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Referral Service CurrentSince Jul 27, 2022 Accepting new patients
Doctors Express of the Beaumont Area PA CurrentSince Dec 13, 2023 Accepting new patients
Southlake Doctors Express, PA PSC Current Accepting new patients
Cerebral Medical Group, a Professional Corporation CurrentSince Aug 10, 2021 Accepting new patients
Doctors Express of the Temple Area, PA Past Accepting new patients

Locations

340 S Lemon Ave
Ste 9892
Walnut, CA 91789
Phone (415) 617-9894

596 E Stacy Rd
Allen, TX 75002
Phone (469) 898-0199

6600 S Mopac Expy
Ste 2180
Austin, TX 78749
Phone (512) 522-3010

8831 N Highway 146
Baytown, TX 77523
Phone (281) 533-8354

3195 Dowlen Rd
Ste 105
Beaumont, TX 77706
Phone (409) 860-1888

9740 Barker Cypress Rd
Ste 108
Cypress, TX 77433
Phone (281) 463-5200

1515 Holcombe Blvd
Houston, TX 77030
Phone (713) 794-5446

1515 Holcombe Blvd
#M
Houston, TX 77030
Phone (713) 792-6127

1515 Holcombe Blvd
#R4212
Houston, TX 77030
Phone (713) 794-5446

6340 N Eldridge Pkwy
Ste O
Houston, TX 77041
Phone (346) 385-9181

6445 FM 1463 Rd
Ste 230
Katy, TX 77494
Phone (281) 990-6890

8850 Spencer Hwy
La Porte, TX 77571
Phone (281) 946-9980

1921 W League City Pkwy
Ste 130
League City, TX 77573
Phone (281) 937-2590

4724 Lakeview Pkwy
Ste 300
Rowlett, TX 75088
Phone (469) 947-6240

2315 E Southlake Blvd
Ste 110
Southlake, TX 76092
Phone (817) 488-9922

Interoperability endpoints

  • Direct secure messaging: kwaldvogel253463@utmdandersoncc.direct-ci.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1568332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659916800000",
    "number": "1023668803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4439",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772104439",
            "telephone_number": "713-792-2991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 HOLCOMBE BLVD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770304000",
            "telephone_number": "713-792-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDVOGEL",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-13",
        "last_updated": "2022-08-08",
        "certification_date": "2022-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP145502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.