Individual provider Active NPI

Amanda A Gujral, AGPCNP-BC

  • Nurse Practitioner
  • Houston, TX
National Provider Identifier
1194376624
Registry record updated Jun 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
1008679 Issued in TX
Practice address
15655 Cypress Wood Medical Dr Ste 100
Houston, TX 77014-1487
Phone
(713) 442-1700
NPI assigned
Sep 25, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 841553 TX
Nurse Practitioner 363L00000X 1008679 TX Primary

Addresses

Primary practice location

15655 Cypress Wood Medical Dr Ste 100
Houston, TX 77014-1487

Mailing address

11511 Shadow Creek Pkwy
Pearland, TX 77584-7298
Phone (713) 442-0000

Other identifiers 1

IdentifierTypeStateIssuer
418496201MedicaidTX

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address agujral23663@direct.kelsey-seybold.com Direct
Other URL amanda.a.gujral@uth.tmc.edu
FHIR URL https://ssrx.ksnet.com/FhirProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

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
I20201214000719 TX Practitioner - Nurse Practitioner 0941612196 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
841553TXMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Practice House Calls LLC Nurse Practitioner CurrentSince Oct 1, 2022 Accepting new patients
Kelsey-Seybold Medical Group, PLLC CurrentSince Jan 4, 2021 Accepting new patients
Advance Pharmacy LLC Past Accepting new patients

Locations

2727 W Holcombe Blvd
Houston, TX 77025
Phone (713) 790-9412

2646 S Loop W
Ste 330
Houston, TX 77054
Phone (281) 888-4407

15655 Cypress Wood Medical Dr
Ste 100
Houston, TX 77014
Phone (713) 442-1700

11511 Shadow Creek Pkwy
Pearland, TX 77584
Phone (713) 442-4997

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1569369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623110400000",
    "number": "1194376624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11511 SHADOW CREEK PKWY",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775847298",
            "telephone_number": "713-442-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15655 CYPRESS WOOD MEDICAL DR STE 100",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770141487",
            "telephone_number": "713-442-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUJRAL",
        "first_name": "AMANDA",
        "middle_name": "A",
        "credential": "AGPCNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-25",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "841553",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "1008679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "418496201",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "agujral23663@direct.kelsey-seybold.com",
            "affiliation": "N",
            "endpointDescription": "digital contact information",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "15655 Cypress Wood Medical Dr Ste 100",
            "city": "Houston",
            "state": "TX",
            "country_code": "US",
            "postal_code": "770141487",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "amanda.a.gujral@uth.tmc.edu",
            "affiliation": "N",
            "address_1": "1822 Brun St",
            "city": "Houston",
            "state": "TX",
            "country_code": "US",
            "postal_code": "770195713",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://ssrx.ksnet.com/FhirProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FHIR endpoint URL",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "15655 Cypress Wood Medical Dr Ste 100",
            "city": "Houston",
            "state": "TX",
            "country_code": "US",
            "postal_code": "770141487",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.