Active NPI
Krystal Dawn Nelson, OD
- Optometrist
- Gallup, NM
National Provider Identifier
1851961445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 12351314-9934
- Practice address
- 516 East Nizhoni Blvd
Gallup, NM 87301 - Phone
- (505) 722-1000
- NPI assigned
- Jun 28, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Optometrist | 152W00000X | 12351314-9934 | UT | Primary |
Addresses
Primary practice location
516 East Nizhoni Blvd
Gallup, NM 87301
Mailing address
19125 US Highway 18
Batesland, SD 57716-3072
Phone (308) 360-3633
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: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3051 Vintage Blvd
200 Searhc Behav HLTH
Juneau, AK 99801-2807
Phone (907) 364-4445
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 78.18 of 100
- Quality
- 61.12
- Improvement activities
- 40
- Cost
- 81.87
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12351314-9934 | UT | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeast Alaska Regional Health Consortium | Current | Accepting new patients | |
| DHHS, PHS, Naihs, Gallup Indian Medical Center | Current | Accepting new patients | |
| DHHS,PHS,Naihs, Gallup Indian Medical Center | Current | Accepting new patients | |
| Southeast Alaska Regional Health Consortium | Current | Accepting new patients | |
| Southeast Alaska Regional Health Consortium | Current | Accepting new patients | |
| South East Alaska Regional Health Consortium | Past | Accepting new patients |
Locations
3100 Channel Dr
Ste 300
Juneau, AK 99801
Phone (907) 463-4000
3051 Vintage Blvd
Ste 200
Juneau, AK 99801
Phone (907) 364-4445
3051 Vintage Blvd
#200
Juneau, AK 99801
222 Tongass Dr
Sitka, AK 99835
Phone (907) 966-8423
516 E Nizhoni Blvd
Gallup, NM 87301
Phone (505) 722-1326
Organizations & group practices 6
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.
-
- General Acute Care Hospital
- Gallup, NM
- NPI 1225002322
TX
-
- Federal Public Health Clinic/Center
- Tohatchi, NM
- NPI 1902875594
-
- Community/Behavioral Health Agency
- Petersburg, AK
- NPI 1174108880
-
- Clinic/Center
- Juneau, AK
- NPI 1427941343
-
- Clinic/Center
- Wrangel, AK
- NPI 1487836391
Hospital & facility affiliations 35
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Clinic/Center
- Tenakee Springs, AK
- NPI 1477721280
Hospital
-
- Nursing Facility/Intermediate Care Facility
- Juneau, AK
- NPI 1932312485
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628121600000",
"number": "1851961445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19125 US HIGHWAY 18",
"city": "BATESLAND",
"state": "SD",
"postal_code": "577163072",
"telephone_number": "308-360-3633"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "516 EAST NIZHONI BLVD",
"city": "GALLUP",
"state": "NM",
"postal_code": "87301",
"telephone_number": "505-722-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "KRYSTAL",
"middle_name": "DAWN",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-06-28",
"last_updated": "2021-08-05",
"certification_date": "2021-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "UT",
"license": "12351314-9934",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gallup, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2021; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.