Active NPI
Tom P Keolasy, PA-C
- Physician Assistant
- San Antonio, TX
National Provider Identifier
1457443608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA04979
- Practice address
- 810 SE Military Drive
San Antonio, TX 78214-2823 - Phone
- (210) 921-4200
- Fax
- (210) 922-8181
- NPI assigned
- Sep 28, 2006
- Last updated
- Feb 9, 2015
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA04979 | TX | Primary |
Addresses
Primary practice location
810 SE Military Drive
San Antonio, TX 78214-2823
Mailing address
2961 Mossrock
San Antonio, TX 78230-5119
Phone (210) 731-4800
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA04979 | TX | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Military Apothecary LP | Past | Accepting new patients |
Organizations & group practices 1
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": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423440000000",
"number": "1457443608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2961 MOSSROCK",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782305119",
"telephone_number": "210-731-4800",
"fax_number": "210-731-8410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "810 SE MILITARY DRIVE",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782142823",
"telephone_number": "210-921-4200",
"fax_number": "210-922-8181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEOLASY",
"first_name": "TOM",
"middle_name": "P",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-28",
"last_updated": "2015-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA04979",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.