NPI age
20 years
Enumerated 2006-05-27
● Active Type 2 · Organization
Kellum Medical Group, PA
Kellum Medical Group, PA is 1 of 15966 family medicine organizations in Texas.
Primary specialty
Family Medicine
Plus 4 secondary
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Braker
Contract Management
Last NPPES update
2026-03-09
Source: monthly bulk 2026-05
How this organization compares
Across 15966 active family medicine providers in Texas.
NPI age
20 years
↑ 3 yr above median
Practice locations
1
0 secondary on file
Subspecialties
4
In the 26% of peers with subspecialties
NPI lifetime · 2006 → 2026
2006-05Enumerated in NPPES
2006
2026
Where they practice
Primary practice location
7323 Marbach Rd Ste 104
San Antonio, TX 782271905
Mailing address
7323 Marbach Rd Ste 104
San Antonio, TX 782271905
Authorized official
Kristi Braker
Contract Management
📞 2106740257
Individual providers at this organization
8 individual providers on file at this primary practice address.
- Alice Blackmon, PNP-C Nurse Practitioner NPI 1265413264
- Surayyo Bobodzhanova, FNP-C Nurse Practitioner NPI 1730450578
- Jeanette Crenshaw, MSN, APRN, FNP-BC Nurse Practitioner NPI 1871287003
- Kimberly Diaz, PA-C Physician Assistant NPI 1366623639
- Daniel Kellum, DO Family Medicine NPI 1174518625
- Denise Kellum, PA-C Physician Assistant NPI 1396908950
- Cynthia Lafuente, FNP-C Nurse Practitioner NPI 1922967892
- Salvador Vazquez, MD Family Medicine NPI 1588641377
Specialties
-
Family Medicine PrimaryFamily 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...
-
Nurse PractitionerDefinition to come...
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Nurse PractitionerDefinition to come...
-
Physician AssistantDefinition to come...
-
Physician AssistantA physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 45D1026258 | CLIA - KELLUM MEDICAL GROUP, PA - PEDIATRICS |
| 01 (TX) | 1174518625 | DANIEL H KELLUM SR., DO - NPI |
| 01 (TX) | CH6982 | MEDICARE RR GROUP PTAN# |
| 01 (TX) | 1265413264 | ALICE T. BLACKMON, NP-C / NPI# |
| 01 (TX) | 1588641377 | SALVADOR VAZQUEZ, MD / NPI# |
| 01 (TX) | 193200000X | GROUP TAXONOMY |
| 01 (TX) | 1346646510 | MATTHEW ARISMENDEZ, PA-C / NPI# |
| 01 (TX) | R-14400 | RADIOLOGY & X-RAY CERT# |
| 01 (TX) | 00295N | MEDICARE GROUP PTAN# |
| 01 (TX) | 1063070308 | MANUELA BERRY, NP-C / NPI# |
| 01 (TX) | 45D0671939 | CLIA - KELLUM MEDICAL GROUP, PA |
| 01 (TX) | 1366623639 | KIMBERLY 'KIM' DIAZ, PA-C |
| 05 (TX) | 1508813494 |
Practice context
Multi-provider organization. 8 individual providers on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.