Individual provider Active NPI

Krystal Ann Estrada, MD

  • Family Medicine Physician
  • Waco, TX
National Provider Identifier
1851730022
Registry record updated Feb 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
Q6185 Issued in TX
Practice address
1600 Providence Drive
Waco, TX 76707
Phone
(254) 313-4200
Fax
(254) 313-4531
NPI assigned
Jun 20, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X BP10047960 TX
Family Medicine Physician 207Q00000X Q6185 TX Primary

Addresses

Primary practice location

1600 Providence Drive
Waco, TX 76707

Mailing address

1600 Providence Dr
Waco, TX 76707-2261
Phone (254) 313-4200

Other names 1

  • Krystal Scott Former name

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
I20160303000407 TX Practitioner - Family Practice 3274839139 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
BP10047960TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mother Frances Hospital Regional Health Care Center CurrentSince Mar 1, 2020 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Aug 21, 2016 Accepting new patients
Christus Trinity Clinic Texas Family Medicine CurrentSince Aug 21, 2016 Accepting new patients
Mother Frances Hospital Jacksonville CurrentSince Mar 1, 2020 Accepting new patients

Locations

1505 State Highway 19 S
Athens, TX 75751
Phone (903) 675-1725

2026 S Jackson St
Jacksonville, TX 75766
Phone (903) 541-4500

3203 S Main St
Lindale, TX 75771
Phone (903) 266-4000

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

800 E Dawson St
Tyler, TX 75701
Phone (903) 531-5018

Organizations & group practices 4

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": "1371686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455148800000",
    "number": "1851730022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 PROVIDENCE DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767072261",
            "telephone_number": "254-313-4200",
            "fax_number": "254-313-4326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 PROVIDENCE DRIVE",
            "city": "WACO",
            "state": "TX",
            "postal_code": "76707",
            "telephone_number": "254-313-4200",
            "fax_number": "254-313-4531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ESTRADA",
        "first_name": "KRYSTAL",
        "middle_name": "ANN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-20",
        "last_updated": "2016-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "BP10047960",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "Q6185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRYSTAL",
            "last_name": "SCOTT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.