NPIMap

Individual provider Active NPI

Ken Kim Kristofferson, PA

  • Physician Assistant
  • El Paso, TX
National Provider Identifier
1154341584
Registry record updated Jun 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA02936 Issued in TX
Practice address
7420 Remcon Circle
BLDG. a
El Paso, TX 79912
Phone
(915) 532-8823
Fax
(915) 532-5909
NPI assigned
Jul 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA02936 TX Primary
Surgical Physician Assistant 363AS0400X PA02936 TX

Addresses

Primary practice location

7420 Remcon Circle
BLDG. a
El Paso, TX 79912

Mailing address

7420 Remcon Cir
BLDG a
El Paso, TX 79912-3529
Phone (915) 532-8823

Other identifiers 4

IdentifierTypeStateIssuer
PA02936OtherTXPA LICENSE
192820202MedicaidTX
76300323MedicaidNM
192820203MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040505001026 TX Practitioner - Physician Assistant 7315935517 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rio Grande Urology PAGroup PAC ID 3476627878, 28 clinicians

Practice addresses (Care Compare)

2201 N Stanton
El Paso, TX 79902-3211
Phone (915) 533-0800

2201 N Stanton St
El Paso, TX 79902-3211

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA02936TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Emergency Room Services PA Past Accepting new patients
El Paso Hospitalist Group PLLC Physician Assistant Past Accepting new patients
Aliviane, Inc. PastSince Nov 4, 2024 Accepting new patients
Team Physicians of Arizona PC Physician Assistant Past Accepting new patients
Physicians and Allied Health Professionals Group, PA Past Accepting new patients
Affilion LLC Past Accepting new patients
Texas Em-1 Medical Services, PA Physician Assistant Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kenkristofferson@rgu.medalliesdirect.net

Organizations & group practices 8

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 8

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": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402963200000",
    "number": "1154341584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7420 REMCON CIR",
            "address_2": "BLDG A",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799123529",
            "telephone_number": "915-532-8823",
            "fax_number": "915-532-5909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7420 REMCON CIRCLE",
            "address_2": "BLDG. A",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "79912",
            "telephone_number": "915-532-8823",
            "fax_number": "915-532-5909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRISTOFFERSON",
        "first_name": "KEN",
        "middle_name": "KIM",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2014-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA02936",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "PA02936",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSE",
            "identifier": "PA02936",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "192820202",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "76300323",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "192820203",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

Verify at the official NPI Registry.