Active NPI
Paula Jean Kruppstadt, MD
- Pediatrics Physician
- Shenandoah, TX
National Provider Identifier
1144365487
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- J1104
- Practice address
- 150 Pine Forest Dr Ste 701
Shenandoah, TX 77384-5317 - Phone
- (281) 725-6767
- Fax
- (888) 886-9009
- NPI assigned
- Feb 21, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | J1104 | TX | Primary |
Addresses
Primary practice location
150 Pine Forest Dr Ste 701
Shenandoah, TX 77384-5317
Mailing address
150 Pine Forest Dr Ste 701
Shenandoah, TX 77384-5317
Phone (281) 725-6767
Other names 1
- Dr. Paula Jean Lockhart
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2023 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J1104 | TX | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Texas Children'S Urgent Care | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatrics Physician
- Houston, TX
- NPI 1871998963
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557532800000",
"number": "1144365487",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 PINE FOREST DR STE 701",
"city": "SHENANDOAH",
"state": "TX",
"postal_code": "773845317",
"telephone_number": "281-725-6767",
"fax_number": "888-886-9009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 PINE FOREST DR STE 701",
"city": "SHENANDOAH",
"state": "TX",
"postal_code": "773845317",
"telephone_number": "281-725-6767",
"fax_number": "888-886-9009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUPPSTADT",
"first_name": "PAULA",
"middle_name": "JEAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-21",
"last_updated": "2019-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "J1104",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "PAULA",
"last_name": "LOCKHART",
"middle_name": "JEAN",
"prefix": "DR.",
"credential": "MD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Shenandoah, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.