Kevin Ray Buckwalter, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

8476 Issued in NV

Practice address

7151 Cascade Valley CT Ste 200
Las Vegas, NV 89128-0498

Phone

(702) 568-8450

Fax

(702) 568-8451

NPI assigned

Jun 30, 2005

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1003813478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1280 MONUMENT BLVD",
            "address_2": "# 1",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945204405",
            "telephone_number": "916-733-6993",
            "fax_number": "916-733-6989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7151 CASCADE VALLEY CT STE 200",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280498",
            "telephone_number": "702-568-8450",
            "fax_number": "702-568-8451"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1280 MONUMENT BLVD",
            "address_2": "# 1",
            "address_purpose": "LOCATION",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945204405",
            "country_code": "US",
            "telephone_number": "916-733-6993",
            "fax_number": "916-733-6989",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUCKWALTER",
        "first_name": "KEVIN",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-30",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A63401",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A63401",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A63401",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NV",
            "license": "8476",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "A63401",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "8476",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE PTAN",
            "identifier": "00A634010",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Buckman, PT
• Lamont Buckman
• Alisha Renee Buckner
• Sabrina Buckner
• Shanell Buckner
• Teresa Patawaran Buco, REGISTERED NURSE
• Angelina D Bucu, NP
• Lindsay Marie Buczek
• Danielle Madeline Buda, D.C.
• Brian Timothy Budd

• General Practice Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• General Practice Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.