Individual provider Active NPI

Shannon Stuart Kratzer, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Austin, TX
National Provider Identifier
1497710347
Registry record updated Apr 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
K6063 Issued in TX
Practice address
3445 Executive Center Dr
Suite 250
Austin, TX 78731-1678
Phone
(512) 579-4000
Fax
(512) 439-2814
NPI assigned
Apr 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X K6063 TX Primary

Addresses

Primary practice location

3445 Executive Center Dr
Suite 250
Austin, TX 78731-1678

Mailing address

3445 Executive Center Dr
Suite 250
Austin, TX 78731-1678
Phone (512) 579-4000

Other identifiers 1

IdentifierTypeStateIssuer
P080P9388MedicaidTX

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20100618000444 TX Practitioner - Pathology 9537204326 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Hurt, Jacknow, Moore, Connor, Wells, Michels, Yurco, Listrom & Huang Anatomic Pathology & Clinical Pathology CurrentSince Jul 15, 1998 Accepting new patients

Locations

3445 Executive Center Dr
Ste 250
Austin, TX 78731
Phone (512) 339-1275

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334534400000",
    "number": "1497710347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3445 EXECUTIVE CENTER DR",
            "address_2": "SUITE 250",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787311678",
            "telephone_number": "512-579-4000",
            "fax_number": "512-439-2814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3445 EXECUTIVE CENTER DR",
            "address_2": "SUITE 250",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787311678",
            "telephone_number": "512-579-4000",
            "fax_number": "512-439-2814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRATZER",
        "first_name": "SHANNON",
        "middle_name": "STUART",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-20",
        "last_updated": "2012-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "TX",
            "license": "K6063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "P080P9388",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.