Active NPI
Kiefer McQuade Starks, DO
- Surgery Physician
- Tacoma, WA
National Provider Identifier
1063155190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- OP61421917
- Practice address
- 1717 S J St
Tacoma, WA 98405-4933 - Phone
- (253) 426-4101
- NPI assigned
- Apr 17, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | OP61421917 | WA | Primary |
Addresses
Primary practice location
1717 S J St
Tacoma, WA 98405-4933
Mailing address
2901 N Manchester PL
Boise, ID 83704-5636
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220629002532 | WA | Order and Referring Only - General Surgery | 5799165361 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OP61421917 | WA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693180800000",
"number": "1063155190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2901 N MANCHESTER PL",
"city": "BOISE",
"state": "ID",
"postal_code": "837045636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1717 S J ST",
"city": "TACOMA",
"state": "WA",
"postal_code": "984054933",
"telephone_number": "253-426-4101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARKS",
"first_name": "KIEFER",
"middle_name": "MCQUADE",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-04-17",
"last_updated": "2023-08-28",
"certification_date": "2023-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WA",
"license": "OP61421917",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; 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.