Active NPI
Michael S Fontenot, MD
- Pediatrics Physician
- Kerrville, TX
National Provider Identifier
1790786937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- J5761
- Practice address
- 1331 Bandera Hwy Ste 10
Kerrville, TX 78028-9535 - Phone
- (830) 257-1440
- Fax
- (830) 257-2542
- NPI assigned
- Aug 10, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | J5761 | TX | Primary |
Addresses
Primary practice location
1331 Bandera Hwy Ste 10
Kerrville, TX 78028-9535
Mailing address
1331 Bandera Hwy Ste 10
Kerrville, TX 78028-9535
Phone (830) 257-1440
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 106116 | Other | TX | SUPERIOR CHIP |
| 130580703 | Medicaid | TX | |
| 0085EY | Other | TX | BCBS |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J5761 | TX | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kerrville Pediatrics | Past | Accepting new patients | |
| Michael S. Fontenot, M.D., P.a. | Pediatrics | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Pediatric Clinical Nurse Specialist
- Kerrville, TX
- NPI 1114292968
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302739200000",
"number": "1790786937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1331 BANDERA HWY STE 10",
"city": "KERRVILLE",
"state": "TX",
"postal_code": "780289535",
"telephone_number": "830-257-1440",
"fax_number": "830-257-2542"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1331 BANDERA HWY STE 10",
"city": "KERRVILLE",
"state": "TX",
"postal_code": "780289535",
"telephone_number": "830-257-1440",
"fax_number": "830-257-2542"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONTENOT",
"first_name": "MICHAEL",
"middle_name": "S",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-10",
"last_updated": "2011-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "J5761",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SUPERIOR CHIP",
"identifier": "106116",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "130580703",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "0085EY",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kerrville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.