Organization Active NPI

Ingram Health Care, P.C.

  • Chiropractor
  • Canton, TX
National Provider Identifier
1366560575
Registry record updated May 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC6688 Issued in TX
Legal business name
INGRAM HEALTH CARE, P.C.
Practice address
921 W Dallas St
Canton, TX 75103-1009
Phone
(903) 567-5579
Fax
(903) 567-5938
NPI assigned
Mar 26, 2007
Last updated
May 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2020

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

Authorized official

Name
Dr. Kristofer Todd Ingram, D.C.NPI 1578651006
Title
President
Phone
(903) 567-5579

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X DC6688 TX Primary

Addresses

Primary practice location

921 W Dallas St
Canton, TX 75103-1009

Mailing address

921 W Dallas St
Canton, TX 75103-1009
Phone (903) 567-5579

Other identifiers 4

IdentifierTypeStateIssuer
87390YOtherTXBC BS
$$$$$$$$$OtherTXSSN
87391YOtherTXBC BS
$$$$$$$$$OtherTXSSN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050404000279 TX Part B Supplier - Clinic/Group Practice 8224085147 Receives reassigned benefits from 2 practitioners
Practice locations: Canton, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D1066981Ingram Health Care PC921 W Dallas, Canton, TX 75103Certificate of waiverApr 5, 2027

National Provider Directory

National Provider Directory

Locations

921 W Dallas St
Canton, TX 75103
Phone (903) 567-5579

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590019200000",
    "number": "1366560575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 W DALLAS ST",
            "city": "CANTON",
            "state": "TX",
            "postal_code": "751031009",
            "telephone_number": "903-567-5579",
            "fax_number": "903-567-5938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 W DALLAS ST",
            "city": "CANTON",
            "state": "TX",
            "postal_code": "751031009",
            "telephone_number": "903-567-5579",
            "fax_number": "903-567-5938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INGRAM HEALTH CARE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2020-05-21",
        "status": "A",
        "authorized_official_last_name": "INGRAM",
        "authorized_official_first_name": "KRISTOFER",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "903-567-5579",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "DC6688",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS",
            "identifier": "87390Y",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SSN",
            "identifier": "$$$$$$$$$",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS",
            "identifier": "87391Y",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SSN",
            "identifier": "$$$$$$$$$",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2020; 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.