Jennifer Soohyun Kwak, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

L4029 Issued in TX

Practice address

15040 Fairfield Village Square Dr
Suite 150
Cypress, TX 77433-5952

Phone

(281) 304-5100

NPI assigned

Sep 29, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Texas Medical School at San Antonio, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Privia Medical Group Gulf Coast PLLCGroup PAC ID 4688999022, 511 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Hermann - Texas Medical Center Hospital, Houston, TX, CCN 450068
• Houston Methodist Cypress Hospital Hospital, Cypress, TX, CCN 670342
• HCA Houston Healthcare Tomball Hospital, Tomball, TX, CCN 450670
• HCA Houston Healthcare Kingwood Hospital, Kingwood, TX, CCN 450775

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jennifer.kwak.1@8042.direct.athenahealth.com

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.

• Privia Medical Group Gulf Coast, PLLC

  • Obstetrics & Gynecology Physician
  • Houston, TX
  • NPI 1578969465
  Medicare reassignment Care Compare group NPD
• Privia Medical Group Gulf Coast PLLC

  • Interventional Pain Medicine Physician
  • San Antonio, TX
  • NPI 1457167033
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• KPH-Consolidation, Inc.

  • General Acute Care Hospital
  • Kingwood, TX
  • NPI 1811942238
  Care Compare affiliation
• Memorial Hermann Health System

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Houston, TX
  • NPI 1437189115

  Hospital

  Care Compare affiliation
• Memorial Hermann Health System

  • General Acute Care Hospital
  • Houston, TX
  • NPI 1982666111
  Care Compare affiliation
• Methodist Health Centers

  • General Acute Care Hospital
  • Cypress, TX
  • NPI 1629828405
  Care Compare affiliation
• North Houston - TRMC, LLC

  • General Acute Care Hospital
  • Tomball, TX
  • NPI 1750819025
  Care Compare affiliation

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190246400000",
    "number": "1427045145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15040 FAIRFIELD VILLAGE SQUARE DR # 150",
            "city": "CYPRESS",
            "state": "TX",
            "postal_code": "774335952",
            "telephone_number": "281-304-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15040 FAIRFIELD VILLAGE SQUARE DR",
            "address_2": "SUITE 150",
            "city": "CYPRESS",
            "state": "TX",
            "postal_code": "774335952",
            "telephone_number": "281-304-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWAK",
        "first_name": "JENNIFER",
        "middle_name": "SOOHYUN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-29",
        "last_updated": "2007-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L4029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "159739501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shannon Isabel Kuruvilla, MD
• Vigi Kuruvilla, LCSW
• Oladipo Ajose Kusemiju, M.D.
• Nicole Kuttschreuter
• Kuvis Dental PLLC
• Sarah M Kwang, D.D.S.
• Melanie Kwok, DPT, PT
• L & a Professional Services, LLC
• L J Counseling and Community Services
• L. B. Johnson Therapeutics, PLLC

• Family Medicine Physician in Cypress, TX
• Providers in Cypress, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.