Individual provider Active NPI

Peter Kumasaka, MD

  • Emergency Medicine Physician
  • Saint Paul, MN
National Provider Identifier
1063489029
Registry record updated Jun 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
36596 Issued in MN
Practice address
640 Jackson St
MC 11102F
St Paul, MN 55101-2502
Phone
(651) 254-3456
Fax
(651) 254-5216
NPI assigned
Mar 8, 2006
Last updated
Jun 29, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 36596 MN Primary
Emergency Medicine Physician 207P00000X 36069 WI

Addresses

Primary practice location

640 Jackson St
MC 11102F
St Paul, MN 55101-2502

Mailing address

8100 34TH Ave S
Mc21110Q
Bloomington, MN 55425-1672
Phone (952) 883-7172

Other practice location 1

535 Hospital Rd
New Richmond, WI 54017-1449
Phone (715) 243-2600

Other practice location 2

405 Stageline Rd
Hudson, WI 54016-7848
Phone (715) 531-6000

Other identifiers 1

IdentifierTypeStateIssuer
995018400MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20070118000554 MN Practitioner - Emergency Medicine 7618978586 Reassigns benefits to 3 organizations
I20090407000582 WI Practitioner - Emergency Medicine 7618978586 Reassigns benefits to 4 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Regions Hospital CurrentSince Jan 1, 2007 Accepting new patients
Regions Hospital CurrentSince Jan 1, 2007 Accepting new patients
Regions Hospital Emergency Medicine Current Accepting new patients
Hudson Hospital, Inc. CurrentSince Jan 1, 2014 Accepting new patients
Lakeview Memorial Hospital Association Inc CurrentSince Aug 6, 2017 Accepting new patients
Hudson Hospital, Inc. CurrentSince Jan 1, 2014 Accepting new patients
Westfields Hospital, Inc CurrentSince Sep 24, 2017 Accepting new patients
Group Health, Inc. CurrentSince Jan 20, 2023 Accepting new patients
Lakeview Memorial Hospital Association Inc. Emergency Medicine CurrentSince Aug 6, 2017 Accepting new patients
Westfields Hospital, Inc. CurrentSince Sep 24, 2017 Accepting new patients
Group Health, Inc. CurrentSince Jan 20, 2023 Accepting new patients
Hudson Hospital, Inc Past Accepting new patients
Westfields Hospital, Inc. Past Accepting new patients

Locations

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

640 Jackson St
Saint Paul, MN 55101
Phone (651) 221-2164

640 Jackson St
#11102F
Saint Paul, MN 55101
Phone (651) 254-3456

1500 Curve Crest Blvd W
Stillwater, MN 55082

921 Greeley St S
Stillwater, MN 55082

927 Churchill St W
Stillwater, MN 55082
Phone (651) 430-4529

405 Stageline Rd
Hudson, WI 54016
Phone (715) 531-6000

535 Hospital Rd
New Richmond, WI 54017
Phone (651) 292-2013

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

NPI Registry JSON

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687996800000",
    "number": "1063489029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8100 34TH AVE S",
            "address_2": "MC21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554251672",
            "telephone_number": "952-883-7172",
            "fax_number": "952-883-5395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 JACKSON ST",
            "address_2": "MC 11102F",
            "city": "ST PAUL",
            "state": "MN",
            "postal_code": "551012502",
            "telephone_number": "651-254-3456",
            "fax_number": "651-254-5216"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "535 Hospital Rd",
            "address_purpose": "LOCATION",
            "city": "New Richmond",
            "state": "WI",
            "postal_code": "540171449",
            "country_code": "US",
            "telephone_number": "715-243-2600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "405 Stageline Rd",
            "address_purpose": "LOCATION",
            "city": "Hudson",
            "state": "WI",
            "postal_code": "540167848",
            "country_code": "US",
            "telephone_number": "715-531-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUMASAKA",
        "first_name": "PETER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-08",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MN",
            "license": "36596",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "36069",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "995018400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.