Individual provider Active NPI

Kyle Stuart Bruun, MD

  • General Practice Physician
  • Bethesda, MD
National Provider Identifier
1013775469
Registry record updated Jul 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
0101286776 Issued in VA
Practice address
4954 N Palmer Rd
Bethesda, MD 20889-5630
Phone
(301) 295-0451
NPI assigned
Mar 11, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Military Health Care Provider 171000000X
General Practice Physician 208D00000X 0101286776 VA Primary

Addresses

Primary practice location

4954 N Palmer Rd
Bethesda, MD 20889-5630

Mailing address

4954 N Palmer Rd
Bethesda, MD 20889-5630

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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

Enrollment IDStateProvider typePAC IDDetails
I20250721000095 VA Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 1951817618

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101286776VAMDGeneral Practice Physician

NPI Registry JSON

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

{
    "created_epoch": "1710115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751846400000",
    "number": "1013775469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4954 N PALMER RD",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208895630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4954 N PALMER RD",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208895630",
            "telephone_number": "301-295-0451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUUN",
        "first_name": "KYLE",
        "middle_name": "STUART",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-03-11",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "VA",
            "license": "0101286776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethesda, MD

Sources for this page

Verify at the official NPI Registry.