CRYSTAL PARK
NPI 1043911936
Nurse Practitioner - Acute Care in Houston, TX
About Crystal Park NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CRYSTAL PARK (NPI 1043911936) is an individual acute care provider in Houston, Texas, licensed in Texas (1103075) and active in the NPI registry since March 2023. She is enrolled in Medicare PECOS and is a graduate of Other (2023).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Crystal Park is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Crystal Park reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Beaumont, TX 77702
- Reassigned Medicare billing, Texas enrollment
- 84 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 77030 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
HOUSTON, TX 77030
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Crystal Park's NPI number?
The NPI number for Crystal Park is 1043911936. It was assigned to this individual provider in the NPPES registry on March 16, 2023.
Where is Crystal Park located?
Crystal Park practices at 6411 Fannin St, Houston, TX 77030. The listed phone number is (713) 704-4000.
What is Crystal Park's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Acute Care, with taxonomy code 363LA2100X.
Is Crystal Park enrolled in Medicare?
Yes. Crystal Park is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Crystal Park's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Crystal Park reassigns Medicare benefits to Southeast Texas Intensivists, PLLC (Beaumont, TX). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Crystal Park's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Crystal Park accept?
Health plans from Blue Cross and Blue Shield of Texas list Crystal Park as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Crystal Park was last updated on March 19, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Crystal Park · NPI 1043911936
Acute Care physician in Houston, Texas. Individual provider, active in the CMS NPPES registry since March 16, 2023.
## Identity
- **NPI:** 1043911936 (Entity type: Individual)
- **Enumerated:** March 16, 2023
- **Primary specialty:** Nurse Practitioner - Acute Care · taxonomy 363LA2100X
- **State license:** 1103075 (Texas)
- **Sole proprietor:** No
## Practice location
- **Address:** 6411 FANNIN ST, Houston, TX 77030-1501
- **Phone:** (713) 704-4000
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Southeast Texas Intensivists, PLLC (NPI 1801579867, Beaumont, TX), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2023
## Record status
- **NPPES last updated:** March 19, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1043911936) · Data from the CMS NPPES public registry.