Individual provider Active NPI

Ken Shelton Locke, P.A.

  • Medical Physician Assistant
  • San Antonio, TX
National Provider Identifier
1295032704
Registry record updated Feb 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA01080 Issued in TX
Practice address
7940 Floyd Curl
Ste 630
San Antonio, TX 78229-3905
Phone
(210) 614-1112
Fax
(210) 614-1113
NPI assigned
Feb 17, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA01080 TX Primary

Addresses

Primary practice location

7940 Floyd Curl
Ste 630
San Antonio, TX 78229-3905

Mailing address

7940 Floyd Curl
Ste 630
San Antonio, TX 78229-3905
Phone (210) 614-1112

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190513000517 TX Practitioner - Physician Assistant 4688917776 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

12000 Huebner Rd
Suite 104
San Antonio, TX 78230-1209

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group Gulf Coast PLLC CurrentSince Apr 1, 2020 Accepting new patients
Privia Medical Group Gulf Coast, PLLC CurrentSince Apr 1, 2020 Accepting new patients
Harr and Deschner PA Past Accepting new patients
Greater San Antonio Emergency Physicians, PA Past Accepting new patients

Locations

7900 Fannin St
Ste 4000
Houston, TX 77054
Phone (713) 512-7027

12000 Huebner Rd
Ste 104
San Antonio, TX 78230
Phone (210) 561-2422

Interoperability endpoints

  • Direct secure messaging: ken.locke.1@8042.direct.athenahealth.com

Organizations & group practices 4

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": "1297900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297900800000",
    "number": "1295032704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7940 FLOYD CURL",
            "address_2": "STE 630",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293905",
            "telephone_number": "210-614-1112",
            "fax_number": "210-614-1113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7940 FLOYD CURL",
            "address_2": "STE 630",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293905",
            "telephone_number": "210-614-1112",
            "fax_number": "210-614-1113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOCKE",
        "first_name": "KEN",
        "middle_name": "SHELTON",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-02-17",
        "last_updated": "2011-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA01080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.