NPIMap

Individual provider Active NPI

Devon Reese Kienzle, DO

  • Family Medicine Physician
  • Darrington, WA
National Provider Identifier
1003313222
Registry record updated Sep 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OP61073204 Issued in WA
Practice address
1190 Riddle St
Darrington, WA 98241-7722
Phone
(360) 436-1055
Fax
(360) 436-0146
NPI assigned
Apr 13, 2018
Last updated
Sep 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OP61073204 WA Primary

Addresses

Primary practice location

1190 Riddle St
Darrington, WA 98241-7722

Mailing address

1400 E Kincaid St
Mount Vernon, WA 98274-4127

Other practice location 1

3823 172nd St NE
Arlington, WA 98223-7735
Phone (360) 428-2500

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dkienzle19930@skagit.direct-ci.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, WA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210630002004 TX Practitioner - Family Practice 8022362664 Reassigns benefits to 1 organization
I20210923001379 WA Practitioner - Family Practice 8022362664 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Touro Un Col of Osteopathic Medicine, Henderson, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Public Hospital Dist No 1 SkagitGroup PAC ID 6800793522, 321 clinicians

Practice addresses (Care Compare)

1190 Riddle St
Darrington, WA 98241-7722
Phone (360) 436-1055

1400 E Kincaid St
Mount Vernon, WA 98274-4127
Phone (360) 428-2500

330 S Stillaguamish Ave
Arlington, WA 98223-1642
Phone (360) 435-2133

3823 172ND St NE
Arlington, WA 98223-7735

407 14TH Ave SE
Puyallup, WA 98372-3770
Phone (253) 697-4000

819 S 13TH St
Mount Vernon, WA 98274-4112
Phone (360) 814-6230

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OP61073204WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Sound Inpatient Physicians PLLC Family Medicine Current Accepting new patients
Public Hospital Dist No 1 Skagit Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Public Hospital Dist No 1 Skagit CurrentSince Sep 13, 2021 Accepting new patients
Hospitalist Medicine Physicians of California-San Bernardino, PC CurrentSince Jun 1, 2022 Accepting new patients
South Sound Inpatient Physicians PLLC Family Medicine CurrentSince Jun 1, 2022 Accepting new patients
Bristol Bay Area Health Corporation CurrentSince Jun 11, 2021 Accepting new patients
Public Hospital Dist No 1 Skagit CurrentSince Sep 13, 2021 Accepting new patients
Bristol Bay Area Health Corporation CurrentSince Jun 11, 2021 Accepting new patients
South Sound Inpatient Physicians PLLC Family Medicine CurrentSince Jun 1, 2022 Accepting new patients
Public Hospital Dist No 1 Skagit Past Accepting new patients
Public Hospital Dist No 1 Skagit Past Accepting new patients
Public Hospital Dist No 1 Skagit Past Accepting new patients

Locations

330 S Stillaguamish Ave
Arlington, WA 98223
Phone (360) 435-2133

3823 172nd St NE
Arlington, WA 98223
Phone (360) 618-5000

1400 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 428-2586

2320 Freeway Dr
Mount Vernon, WA 98273
Phone (360) 814-6800

300 Hospital Pkwy
Mount Vernon, WA 98274
Phone (360) 428-2166

407 14th Ave SE
Puyallup, WA 98372
Phone (253) 697-4000

Interoperability endpoints

  • Direct secure messaging: dkienzle19930@skagit.direct-ci.com

Organizations & group practices 13

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 13

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1523577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631750400000",
    "number": "1003313222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E KINCAID ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 RIDDLE ST",
            "city": "DARRINGTON",
            "state": "WA",
            "postal_code": "982417722",
            "telephone_number": "360-436-1055",
            "fax_number": "360-436-0146"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3823 172nd St NE",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "WA",
            "postal_code": "982237735",
            "country_code": "US",
            "telephone_number": "360-428-2500",
            "fax_number": "360-428-6470",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIENZLE",
        "first_name": "DEVON",
        "middle_name": "REESE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-13",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OP61073204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dkienzle19930@skagit.direct-ci.com",
            "affiliation": "N",
            "endpointDescription": "Provider Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1190 Riddle St",
            "city": "Darrington",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982417722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Darrington, WA

Sources for this page

Verify at the official NPI Registry.