Individual provider Active NPI

Jennifer Krejci-Manwaring, MD

  • Dermatology Physician
  • San Antonio, TX
National Provider Identifier
1578693198
Registry record updated Jun 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
N0185 Issued in TX
Practice address
7400 Merton Minter St # 1a
Audie Murphy Veterans Hospital
San Antonio, TX 78229-4404
Phone
(210) 949-9248
Fax
(210) 949-3107
NPI assigned
Mar 6, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X N0185 TX Primary

Addresses

Primary practice location

7400 Merton Minter St # 1a
Audie Murphy Veterans Hospital
San Antonio, TX 78229-4404

Mailing address

7400 Merton Minter St # 1a
Audie Murphy Veterans Hospital
San Antonio, TX 78229-4404
Phone (210) 949-9248

Other identifiers 1

IdentifierTypeStateIssuer
195506403MedicaidTX

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
I20131021000205 TX Order and Referring Only - DermatologyPractitioner - Dermatology 1658447925

National Provider Directory

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

NPI Registry JSON

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338508800000",
    "number": "1578693198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 MERTON MINTER ST # 1A",
            "address_2": "AUDIE MURPHY VETERANS HOSPITAL",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782294404",
            "telephone_number": "210-949-9248",
            "fax_number": "210-949-3107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7400 MERTON MINTER ST # 1A",
            "address_2": "AUDIE MURPHY VETERANS HOSPITAL",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782294404",
            "telephone_number": "210-949-9248",
            "fax_number": "210-949-3107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KREJCI-MANWARING",
        "first_name": "JENNIFER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-06",
        "last_updated": "2012-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "N0185",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "195506403",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.