NPIMap

Individual provider Active NPI

Ajay Kwatra, MD

  • Urology Physician
  • Conroe, TX
National Provider Identifier
1215024195
Registry record updated Jul 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
J6530 Issued in TX
Practice address
690 S Loop 336 W
Suite 200
Conroe, TX 77304-3319
Phone
(936) 441-1005
Fax
(936) 521-1138
NPI assigned
Oct 10, 2006
Last updated
Jul 13, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 13, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X J6530 TX Primary

Addresses

Primary practice location

690 S Loop 336 W
Suite 200
Conroe, TX 77304-3319

Mailing address

235 Angel Leaf Rd
Spring, TX 77380-2755
Phone (855) 259-2872

Other identifiers 1

IdentifierTypeStateIssuer
103746702MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101228000363 TX Practitioner - Urology 0143315127 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Baylor College of Medicine, 1993
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1020 Riverwood CT
Suite 330
Conroe, TX 77304-2811

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection41

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
J6530TXMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Spring Creek Urology Specialists LLC Urology CurrentSince Feb 1, 2012 Accepting new patients

Locations

1020 Riverwood Ct
Ste 330
Conroe, TX 77304
Phone (855) 259-2872

506 Medical Center Blvd
Ste 304
Conroe, TX 77304
Phone (855) 259-2872

690 S Loop 336 W
Ste 200
Conroe, TX 77304
Phone (832) 262-0435

9305 Pinecroft Dr
Ste 104
The Woodlands, TX 77380
Phone (281) 896-0013

9305 Pinecroft Dr
Ste 303
The Woodlands, TX 77380
Phone (281) 943-2704

9305 Pinecroft Dr
Ste 304
The Woodlands, TX 77380
Phone (832) 510-6553

Interoperability endpoints

  • Direct secure messaging: ajay.kwatra.1@11939.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

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": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468368000000",
    "number": "1215024195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 ANGEL LEAF RD",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773802755",
            "telephone_number": "855-259-2872",
            "fax_number": "888-815-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 S LOOP 336 W",
            "address_2": "SUITE 200",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773043319",
            "telephone_number": "936-441-1005",
            "fax_number": "936-521-1138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWATRA",
        "first_name": "AJAY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2016-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "TX",
            "license": "J6530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103746702",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.