Active NPI
Kirk Steven Dutton, M.D.
- Psychiatry Physician
- Waco, TX
National Provider Identifier
1861494700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- E9613
- Practice address
- 1316 Washington Ave
Waco, TX 76701-1129 - Phone
- (254) 776-1421
- Fax
- (254) 776-1711
- NPI assigned
- Aug 11, 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | E9613 | TX | Primary |
Addresses
Primary practice location
1316 Washington Ave
Waco, TX 76701-1129
Mailing address
1316 Washington Ave
Waco, TX 76701-1129
Phone (254) 776-1421
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 034725401 | Medicaid | TX | |
| 282857 | Other | TX | VALUE OPTIONS |
| 007250000 | Other | TX | MAGELLAN BEHAVIORAL |
| 000000LM23 | Other | TX | BCBS OF TEXAS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E9613 | TX | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316649600000",
"number": "1861494700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1316 WASHINGTON AVE",
"city": "WACO",
"state": "TX",
"postal_code": "767011129",
"telephone_number": "254-776-1421",
"fax_number": "254-776-1711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1316 WASHINGTON AVE",
"city": "WACO",
"state": "TX",
"postal_code": "767011129",
"telephone_number": "254-776-1421",
"fax_number": "254-776-1711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUTTON",
"first_name": "KIRK",
"middle_name": "STEVEN",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-11",
"last_updated": "2011-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "TX",
"license": "E9613",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "034725401",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "282857",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN BEHAVIORAL",
"identifier": "007250000",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF TEXAS",
"identifier": "000000LM23",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2011; 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.