Active NPI
John W Kristensen, M.D.
- Family Medicine Physician
- Raymondville, TX
National Provider Identifier
1316944358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- G2414
- Practice address
- 165 S 6TH St
Raymondville, TX 78580-3521 - Phone
- (956) 689-5506
- Fax
- (956) 689-1988
- NPI assigned
- Jul 6, 2005
- Reactivated
- Apr 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | G2414 | TX | Primary |
Addresses
Primary practice location
165 S 6TH St
Raymondville, TX 78580-3521
Mailing address
165 S 6TH St
Raymondville, TX 78580-3521
Phone (956) 689-5506
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000047206501 | Other | TX | UNITED HEALTHCARE |
| 121472802 | Medicaid | TX | |
| 00SH91 | Other | TX | BC/BS OF TEXAS |
| 110005062 | Other | TX | RAILROAD MEDICARE |
| 742591908 | Other | TX | TRICARE (PGBA) |
| 135937100 | Other | TX | VALLEY BAPTIST HEALTH PLANS |
| 4357806 | Other | TX | AETNA |
| 2869048P01 | Other | TX | CIGNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G2414 | TX | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213315200000",
"number": "1316944358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "165 S 6TH ST",
"city": "RAYMONDVILLE",
"state": "TX",
"postal_code": "785803521",
"telephone_number": "956-689-5506",
"fax_number": "956-689-1988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "165 S 6TH ST",
"city": "RAYMONDVILLE",
"state": "TX",
"postal_code": "785803521",
"telephone_number": "956-689-5506",
"fax_number": "956-689-1988"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRISTENSEN",
"first_name": "JOHN",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-06",
"last_updated": "2008-06-13",
"deactivation_date": "2006-03-20",
"reactivation_date": "2006-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "G2414",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "0000047206501",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "121472802",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS OF TEXAS",
"identifier": "00SH91",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "110005062",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE (PGBA)",
"identifier": "742591908",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALLEY BAPTIST HEALTH PLANS",
"identifier": "135937100",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4357806",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "2869048P01",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Raymondville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.