NPIMap

Organization Active NPI

Shaun Kretzschmar DO PA

  • Family Medicine Physician
  • Aledo, TX
National Provider Identifier
1912379322
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
J9140 Issued in TX
Legal business name
SHAUN KRETZSCHMAR DO PA
Practice address
317 N FM 1187
Aledo, TX 76008-4200
Phone
(817) 441-7181
Fax
(817) 441-7893
NPI assigned
Oct 25, 2015
Organization subpart
Yes
Parent organization
SHAUN KRETZSCHMAR DO PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

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

Authorized official

Name
Dr. Shaun Harding Kretzschmar, D.O.NPI 1386675502
Title
Owner/Physician
Phone
(817) 614-6878

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X J9140 TX Primary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X J1940 TX

Addresses

Primary practice location

317 N FM 1187
Aledo, TX 76008-4200

Mailing address

317 N FM 1187
Aledo, TX 76008-4200
Phone (817) 441-7181

Other names 1

  • Aledo Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160311000109 TX Part B Supplier - Clinic/Group Practice 6800192212 Receives reassigned benefits from 3 practitioners
Practice locations: Aledo, TX

National Provider Directory

National Provider Directory
Part of
Shaun Kretzschmar DO PA

Locations

317 N FM 1187
Aledo, TX 76008
Phone (817) 441-7181

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1445731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724803200000",
    "number": "1912379322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 N FM 1187",
            "city": "ALEDO",
            "state": "TX",
            "postal_code": "760084200",
            "telephone_number": "817-441-7181",
            "fax_number": "817-441-7893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 N FM 1187",
            "city": "ALEDO",
            "state": "TX",
            "postal_code": "760084200",
            "telephone_number": "817-441-7181",
            "fax_number": "817-441-7893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAUN KRETZSCHMAR DO PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHAUN KRETZSCHMAR DO PA",
        "enumeration_date": "2015-10-25",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A",
        "authorized_official_last_name": "KRETZSCHMAR",
        "authorized_official_first_name": "SHAUN",
        "authorized_official_middle_name": "HARDING",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "817-614-6878",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "J9140",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "J1940",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aledo Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aledo, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.