Fristanto Kurniawan, MSN, RN, AGACNP-BC

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

1006744 Issued in TX

Practice address

9250 Pinecroft Dr
Shenandoah, TX 77380-3218

Phone

(713) 897-2300

NPI assigned

Aug 17, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

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.

• Benchmark Inpatient Services PLLC

  • Critical Care Medicine (Internal Medicine) Physician
  • Harlingen, TX
  • NPI 1285111021
  Medicare reassignment NPD
• Hospital Medicine Services of TX, PLLC

  • Hospitalist Physician
  • San Antonio, TX
  • NPI 1881392363
  Medicare reassignment NPD
• Intensivist Medicine Services of TX, PLLC

  • Critical Care Medicine (Internal Medicine) Physician
  • Houston, TX
  • NPI 1790478444
  Medicare reassignment NPD
• Lone Star Intensivists at Gulf Coast, PLLC

  • Critical Care Medicine (Internal Medicine) Physician
  • Webster, TX
  • NPI 1528558236
  Medicare reassignment NPD

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

{
    "created_epoch": "1597622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656979200000",
    "number": "1821600487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 MEDICAL PLAZA DR STE 250",
            "city": "THE WOODLANDS",
            "state": "TX",
            "postal_code": "773803477",
            "telephone_number": "281-296-8788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9250 PINECROFT DR",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773803218",
            "telephone_number": "713-897-2300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17200 St Lukes Way",
            "address_purpose": "LOCATION",
            "city": "The Woodlands",
            "state": "TX",
            "postal_code": "773848007",
            "country_code": "US",
            "telephone_number": "936-288-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17201 I 45 S",
            "address_purpose": "LOCATION",
            "city": "Shenandoah",
            "state": "TX",
            "postal_code": "773853311",
            "country_code": "US",
            "telephone_number": "936-270-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17201 I 45 S",
            "address_purpose": "LOCATION",
            "city": "Shenandoah",
            "state": "TX",
            "postal_code": "773853311",
            "country_code": "US",
            "telephone_number": "936-270-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17200 St Lukes Way",
            "address_purpose": "LOCATION",
            "city": "The Woodlands",
            "state": "TX",
            "postal_code": "773848007",
            "country_code": "US",
            "telephone_number": "936-288-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17201 I 45 S",
            "address_purpose": "LOCATION",
            "city": "Shenandoah",
            "state": "TX",
            "postal_code": "773853311",
            "country_code": "US",
            "telephone_number": "936-270-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17200 St Lukes Way",
            "address_purpose": "LOCATION",
            "city": "The Woodlands",
            "state": "TX",
            "postal_code": "773848007",
            "country_code": "US",
            "telephone_number": "936-288-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KURNIAWAN",
        "first_name": "FRISTANTO",
        "credential": "MSN, RN, AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-17",
        "last_updated": "2022-07-05",
        "certification_date": "2022-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "1006744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Anne Krenz
• Rashi Krishnan, M.D.
• Neeraja Krishnasamudram
• Paula Jean Kruppstadt, MD
• KS Pharm LLC
• Rajnikant Kushwaha, M.D.
• Peter Raymond Kvapil, M.D.
• Kwok Li MD PA
• Francisco Labanca, M.D.
• Patricia E Laden, M.D.

• Acute Care Nurse Practitioner in Shenandoah, TX
• Providers in Shenandoah, TX by specialty
• Acute Care Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.