Organization Active NPI

Urology Assoc of San Antonio PA

  • Urology Physician
  • San Antonio, TX
National Provider Identifier
1801990486
Registry record updated Jul 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
UROLOGY ASSOC OF SAN ANTONIO PA
Practice address
1303 McCullough Ave
Suite 561
San Antonio, TX 78212-5668
Phone
(210) 227-9376
Fax
(210) 227-0916
NPI assigned
Sep 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2010

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

Authorized official

Name
Mr. Jerry Elliot Kruse, MD
Title
President
Phone
(210) 227-9376

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

1303 McCullough Ave
Suite 561
San Antonio, TX 78212-5668

Mailing address

1303 McCullough Ave
Suite 561
San Antonio, TX 78212-5668
Phone (210) 227-9376

Other identifiers 2

IdentifierTypeStateIssuer
083200801MedicaidTX
CP8906OtherTXRAILROAD MEDICARE

National Provider Directory

National Provider Directory

Locations

1303 McCullough Ave
Ste 561
San Antonio, TX 78212
Phone (210) 227-9376

NPI Registry JSON

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278374400000",
    "number": "1801990486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1303 MCCULLOUGH AVE",
            "address_2": "SUITE 561",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782125668",
            "telephone_number": "210-227-9376",
            "fax_number": "210-227-0916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1303 MCCULLOUGH AVE",
            "address_2": "SUITE 561",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782125668",
            "telephone_number": "210-227-9376",
            "fax_number": "210-227-0916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UROLOGY ASSOC OF SAN ANTONIO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-12",
        "last_updated": "2010-07-06",
        "status": "A",
        "authorized_official_last_name": "KRUSE",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "ELLIOT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "210-227-9376",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "083200801",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CP8906",
            "state": "TX"
        }
    ],
    "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 Jul 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.