Active NPI
Jacqueline Anne Krohn, MD MPH
- Pediatrics Physician
- Los Alamos, NM
National Provider Identifier
1942290283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 79195
- Practice address
- 3917 West Rd
Suite 136
Los Alamos, NM 87544-2275 - Phone
- (505) 662-9620
- Fax
- (505) 662-0024
- NPI assigned
- Oct 27, 2005
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 79195 | NM | Primary |
Addresses
Primary practice location
3917 West Rd
Suite 136
Los Alamos, NM 87544-2275
Mailing address
3917 West Rd
Suite 136
Los Alamos, NM 87544-2275
Phone (505) 662-9620
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11783 | Medicaid | NM |
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: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Nov 26, 2012 through Nov 26, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 79195 | NM | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Los Alamos Pediatric Clinic | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- bhi8524@yourcarecommunity.org
Organizations & group practices 1
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.
-
- Pediatrics Physician
- Los Alamos, NM
- NPI 1245248830
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130371200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187222400000",
"number": "1942290283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3917 WEST RD",
"address_2": "SUITE 136",
"city": "LOS ALAMOS",
"state": "NM",
"postal_code": "875442275",
"telephone_number": "505-662-9620",
"fax_number": "505-662-0024"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3917 WEST RD",
"address_2": "SUITE 136",
"city": "LOS ALAMOS",
"state": "NM",
"postal_code": "875442275",
"telephone_number": "505-662-9620",
"fax_number": "505-662-0024"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KROHN",
"first_name": "JACQUELINE",
"middle_name": "ANNE",
"name_prefix": "Dr.",
"credential": "MD MPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-10-27",
"last_updated": "2007-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NM",
"license": "79195",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "11783",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Alamos, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.