Individual provider Active NPI

Kriston A Segura, PSY D

  • Psychologist
  • Las Vegas, NV
National Provider Identifier
1407819071
Registry record updated Nov 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PY0416 Issued in NV
Practice address
2110 E Flamingo Rd Ste 321
Las Vegas, NV 89119-5190
Phone
(702) 308-5114
Fax
(702) 410-8401
NPI assigned
Apr 6, 2006
Last updated
Nov 26, 2018By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 26, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PY0416 NV Primary

Addresses

Primary practice location

2110 E Flamingo Rd Ste 321
Las Vegas, NV 89119-5190

Mailing address

2110 E Flamingo Rd Ste 321
Las Vegas, NV 89119-5190
Phone (702) 308-5114

Other identifiers 1

IdentifierTypeStateIssuer
100503120MedicaidNV

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040517001297 NV Practitioner - Clinical Psychologist 2365432689 Reassigns benefits to 1 organization
Practice locations: Las Vegas, NV

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2110 E Flamingo Rd
Las Vegas, NV 89119-5190
Phone (702) 308-5114

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PY0416NVMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
NV Psych Doc LLC CurrentSince Jun 14, 2018 Accepting new patients
Grgich PC Psychologist Past Accepting new patients

Locations

2110 E Flamingo Rd
Ste 321
Las Vegas, NV 89119
Phone (702) 308-5114

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

NPI Registry JSON

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543190400000",
    "number": "1407819071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 E FLAMINGO RD STE 321",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891195190",
            "telephone_number": "702-308-5114",
            "fax_number": "702-829-5403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2110 E FLAMINGO RD STE 321",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891195190",
            "telephone_number": "702-308-5114",
            "fax_number": "702-410-8401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEGURA",
        "first_name": "KRISTON",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PSY D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-06",
        "last_updated": "2018-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NV",
            "license": "PY0416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100503120",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.