KELLUM MEDICAL GROUP, PA
NPI 1508813494
Family Medicine in San Antonio, TX

NPI Status: Active since May 27, 2006

Contact Information

7323 MARBACH RD STE 104
SAN ANTONIO, TX
ZIP 78227
Phone: (210) 674-0257
Fax: (210) 369-9064

NPI Profile Information
Primary Taxonomy
Secondary Taxonomies
Group Taxonomy
Insurance Plans Accepted
Authorized Official
CLIA Information
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Organization
Family Medicine
Accepts Insurance
CLIA Number: 45D0671939
CLIA Cert. Type: Physician Office
CLIA Exp. Date: 10-02-2026

About KELLUM MEDICAL GROUP, PA

This page provides the complete NPI Profile along with additional information for Kellum Medical Group, Pa, a primary care provider established in San Antonio, Texas operating as a Family Medicine. The healthcare provider is registered in the NPI registry with number 1508813494 assigned on May 2006. The practitioner's primary taxonomy code is 207Q00000X. The provider is registered as an organization and their NPI record was last updated March 2026. Kellum Medical Group, Pa operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Kristi Braker (Contract Management)

NPI: 1508813494
Provider Name: KELLUM MEDICAL GROUP, PA
Entity Type: Organization
Location Address: 7323 MARBACH RD STE 104 SAN ANTONIO, TX 78227
Location Phone: (210) 674-0257
Location Fax: (210) 369-9064
Mailing Address: 7323 MARBACH RD STE 104 SAN ANTONIO, TX 78227
Mailing Phone: (210) 674-0257
Mailing Fax: (210) 369-9064
Is Sole Proprietor?: No
Is Organization Subpart?: No
Enumeration Date: 05-27-2006
Last Update Date: 03-09-2026
Code Navigator

A primary care provider (PCP) like Kellum Medical Group, Pa sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Family Medicine
Taxonomy Code: 207Q00000X
Type: Allopathic & Osteopathic Physicians
Taxonomy Description: Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No.	Taxonomy Code	Type	Classification / Specialization
1	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant
2	363AM0700X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant Medical
3	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner Family
4	363LP0200X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner Pediatrics

Group Taxonomy 193200000X MULTI-SPECIALTY GROUP

This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Ambetter from Arizona Complete Health

Choice Bronze HSA - HMO
Choice Bronze HSA + Vision + Adult Dental - HMO
Complete Gold - HMO
Complete Gold + Vision + Adult Dental - HMO
Complete Silver - HMO
Complete Silver + Vision + Adult Dental - HMO
Elite Gold - HMO
Elite Gold + Vision + Adult Dental - HMO
Everyday Bronze - HMO
Everyday Bronze + Vision + Adult Dental - HMO

Ambetter from Arkansas Health & Wellness

Choice Bronze HSA (QualChoice) - POS
Complete Gold - PPO
Complete Gold + Vision + Adult Dental - PPO
Connected Silver - PPO
Connected Silver (QualChoice) - POS
Connected Silver (QualChoice) + Vision + Adult Dental - POS
Connected Silver (QualChoiceLife) - PPO
Connected Silver (QualChoiceLife) + Vision + Adult Dental - PPO
Connected Silver + Vision + Adult Dental - PPO
Elite Bronze - PPO

Ambetter from Louisiana Healthcare Connections

Complete Gold - EPO
Complete Gold + Vision + Adult Dental - EPO
Elite Bronze - EPO
Elite Bronze + Vision + Adult Dental - EPO
Elite Gold - EPO
Elite Gold + Vision + Adult Dental - EPO
Everyday Bronze - EPO
Everyday Bronze + Vision + Adult Dental - EPO
Focused Silver - EPO
Focused Silver + Vision + Adult Dental - EPO

Ambetter from Superior HealthPlan

Complete Gold - EPO
Complete Gold + Vision + Adult Dental - EPO
Enhanced Diabetes Care Silver with $0 Drug Options - EPO
Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
Everyday Gold - EPO
Everyday Gold + Vision + Adult Dental - EPO
Focused Silver - EPO
Focused Silver + Vision + Adult Dental - EPO
Standard Gold - EPO
Standard Gold + Vision + Adult Dental - EPO

Ambetter of Oklahoma

Elite Bronze - PPO
Elite Bronze + Vision + Adult Dental - PPO
Elite Gold - PPO
Elite Gold + Vision + Adult Dental - PPO
Enhanced Asthma/COPD Care Silver with $0 Drug Options - PPO
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental - PPO
Enhanced Diabetes Care Silver with $0 Drug Options - PPO
Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - PPO
Everyday Bronze - PPO
Everyday Bronze + Vision + Adult Dental - PPO

Blue Cross and Blue Shield of Texas

Blue Advantage Bronze HMO? 204 - HMO
Blue Advantage Bronze HMO? 301 - HMO
Blue Advantage Bronze HMO? Standard - HMO
Blue Advantage Gold HMO? 206 - HMO
Blue Advantage Gold HMO? 603 - HMO
Blue Advantage Gold HMO? Standard - HMO
Blue Advantage Plus Bronze? 303 - POS
Blue Advantage Plus Bronze? 305 - POS
Blue Advantage Plus Bronze? Standard - POS
Blue Advantage Plus Gold? 203 - POS

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name: KRISTI BRAKER
Authorized Official Title: CONTRACT MANAGEMENT
Authorized Official Phone: (210) 674-0257

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier	Type / Code	Identifier State	Identifier Issuer
45D1026258	OTHER (01)	TX	CLIA - KELLUM MEDICAL GROUP, PA - PEDIATRICS
1174518625	OTHER (01)	TX	DANIEL H KELLUM SR., DO - NPI
CH6982	OTHER (01)	TX	MEDICARE RR GROUP PTAN#
1265413264	OTHER (01)	TX	ALICE T. BLACKMON, NP-C / NPI#
1588641377	OTHER (01)	TX	SALVADOR VAZQUEZ, MD / NPI#
193200000X	OTHER (01)	TX	GROUP TAXONOMY
1346646510	OTHER (01)	TX	MATTHEW ARISMENDEZ, PA-C / NPI#
R-14400	OTHER (01)	TX	RADIOLOGY & X-RAY CERT#
00295N	OTHER (01)	TX	MEDICARE GROUP PTAN#
1063070308	OTHER (01)	TX	MANUELA BERRY, NP-C / NPI#
45D0671939	OTHER (01)	TX	CLIA - KELLUM MEDICAL GROUP, PA
1366623639	OTHER (01)	TX	KIMBERLY 'KIM' DIAZ, PA-C
1508813494	MEDICAID (05)	TX

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number: 45D0671939
Facility Type: Physician Office
Certificate Effective Date: October 03, 2024
Certificate Expiration Date: October 02, 2026
Laboratory Director: DANIEL KELLUM SR
Certificate Type: Certificate of Waiver
Certificate Type Description: This CLIA certificate is issued to Kellum Medical Group, Pa to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1508813494, we treat the final digit (4) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 66. The final step is to find the difference between that total and the next multiple of ten (70 - 66 = 4).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 0

Pos 4

Unchanged

Pos 5

Doubled → 16 → 1 + 6

Pos 6

Unchanged

Pos 7

Doubled → 6

Pos 8

Unchanged

Pos 9

Doubled → 18 → 1 + 8

Check

Target digit

Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 0 → 0 8 → 16 → 7 3 → 6 9 → 18 → 9

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 5 + 0 + 8 + 1 + 6 + 1 + 6 + 4 + 1 + 8 + 24 = 66

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 66 is 70. The difference is the calculated check digit.

70 - 66 = 4

This NPI is valid

The calculated check digit is 4, which matches the last digit of 1508813494.