Individual provider Active NPI

Charles Lewis Kieffer, M.D.

  • Emergency Medicine Physician
  • Jbsa Ft Sam Houston, TX
National Provider Identifier
1053842831
Registry record updated Apr 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
T5944 Issued in TX
Practice address
3551 Roger Brooke Dr
Jbsa Ft Sam Houston, TX 78234-4504
Phone
(210) 916-4141
NPI assigned
Mar 23, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 67041 MN
Emergency Medicine Physician 207P00000X T5944 TX Primary
Emergency Medicine Physician 207P00000X R4465 KY

Addresses

Primary practice location

3551 Roger Brooke Dr
Jbsa Ft Sam Houston, TX 78234-4504

Mailing address

3551 Roger Brooke Dr
Fort Sam Houston, TX 78234-4504
Phone (952) 463-5575

Other practice location 1

1025 Marsh St
Mankato, MN 56001-4752
Phone (507) 625-4031

Other practice location 2

1100 Wilford Hall Loop Bldg 4554
Jbsa Lackland, TX 78236-5638
Phone (952) 463-5575

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200519001886 MN Practitioner - Emergency Medicine 1658629738 Reassigns benefits to 6 organizations
I20220429001114 TX Practitioner - Emergency Medicine 1658629738 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Saint Louis University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prestige Emergency Consultants LLCGroup PAC ID 5991135386, 11 clinicians

Practice addresses (Care Compare)

2810 N Loop 1604
Suite 110
San Antonio, TX 78248-2230
Phone (210) 504-4837

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
R4465KYMDEmergency Medicine Physician
67041MNMDEmergency Medicine Physician
T5944TXMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-Southwest Minnesota Region Current Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region Current Accepting new patients
Mayo Clinic Health System-Fairmont CurrentSince Jul 1, 2020 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Jul 1, 2020 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Jul 1, 2020 Accepting new patients
Mayo Clinic Health System-St James Current Accepting new patients
Emergency Medicine Services of TX, PLLC Emergency Medicine CurrentSince Apr 1, 2023 Accepting new patients
Mayo Clinic Health System-St James CurrentSince Jul 1, 2020 Accepting new patients
Radiology Associates of Southwest Louisiana Past Accepting new patients

Locations

800 Medical Center Dr
Fairmont, MN 56031
Phone (507) 238-8100

1025 Marsh St
Mankato, MN 56001
Phone (507) 345-2623

1101 Moulton and Parsons Dr
Saint James, MN 56081
Phone (507) 375-3261

501 State St N
Waseca, MN 56093
Phone (507) 835-1210

100 E Alton Gloor Blvd
Brownsville, TX 78526
Phone (956) 350-7000

1020 S State Highway 16
Fredericksburg, TX 78624
Phone (830) 990-1555

225 E Parkwood Ave
Friendswood, TX 77546
Phone (281) 549-9400

12285 Bandera Rd
Helotes, TX 78023
Phone (210) 575-2285

1905 E State Highway 97
Jourdanton, TX 78026
Phone (210) 614-9603

12412 Judson Rd
Live Oak, TX 78233
Phone (210) 646-5000

11100 Shadow Creek Pkwy
Pearland, TX 77584
Phone (713) 770-7000

13434 Nacogdoches Rd
San Antonio, TX 78217
Phone (210) 447-7560

1310 McCullough Ave
San Antonio, TX 78212
Phone (210) 208-2200

6402 Mallard Mdw
San Antonio, TX 78244
Phone (210) 757-5000

12805 W Interstate 10
San Antonio, TX 78249
Phone (210) 575-9805

3154 SE Military Dr
Ste 103
San Antonio, TX 78223
Phone (210) 337-0911

6700 W Interstate 10
San Antonio, TX 78201
Phone (210) 575-8289

250 E Basse Rd
Ste 101
San Antonio, TX 78209
Phone (210) 638-4159

7700 Floyd Curl Dr
San Antonio, TX 78229
Phone (210) 575-5564

9211 Potranco Rd
San Antonio, TX 78251
Phone (210) 575-9211

20475 State Highway 46 W
Ste 100
Spring Branch, TX 78070
Phone (830) 252-5200

26306 Kuykendahl Rd
Tomball, TX 77375
Phone (346) 246-7700

Organizations & group practices 10

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

Hospital & facility affiliations 3

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": "1490227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712620800000",
    "number": "1053842831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3551 ROGER BROOKE DR",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344504",
            "telephone_number": "952-463-5575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3551 ROGER BROOKE DR",
            "city": "JBSA FT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344504",
            "telephone_number": "210-916-4141"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1025 Marsh St",
            "address_purpose": "LOCATION",
            "city": "Mankato",
            "state": "MN",
            "postal_code": "560014752",
            "country_code": "US",
            "telephone_number": "507-625-4031",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1100 Wilford Hall Loop Bldg 4554",
            "address_purpose": "LOCATION",
            "city": "Jbsa Lackland",
            "state": "TX",
            "postal_code": "782365638",
            "country_code": "US",
            "telephone_number": "952-463-5575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIEFFER",
        "first_name": "CHARLES",
        "middle_name": "LEWIS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-23",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MN",
            "license": "67041",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "T5944",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "KY",
            "license": "R4465",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jbsa Ft Sam Houston, TX

Sources for this page

Verify at the official NPI Registry.