NPIMap

Individual provider Active NPI

Stephen M. Kruk, D.O.

  • Internal Medicine Physician
  • Du Bois, PA
National Provider Identifier
1073544375
Registry record updated Oct 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS-005395-L Issued in PA
Practice address
145 Hospital Ave
Suite 215
Du Bois, PA 15801-1462
Phone
(814) 371-1717
Fax
(814) 375-4422
NPI assigned
Jul 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OS-005395-L PA Primary

Addresses

Primary practice location

145 Hospital Ave
Suite 215
Du Bois, PA 15801-1462

Mailing address

145 Hospital Ave 215
Du Bois, PA 15801-1464
Phone (814) 371-1717

Other identifiers 1

IdentifierTypeStateIssuer
001065654MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050322000282 PA Practitioner - Internal Medicine 8022063155 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Philadelphia College of Osteopathic Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dubois Regional Medical CenterGroup PAC ID 5890689715, shared by 39 NPIs, 424 clinicians

Practice addresses (Care Compare)

145 Hospital Ave
Suite 101
Du Bois, PA 15801-1463
Phone (814) 375-4089

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.6 of 100Reported as group
Promoting interoperability
96
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS-005395-LPAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dubois Regional Medical Center Internal Medicine CurrentSince Jan 1, 2005 Accepting new patients
Dubois Regional Medical Center Internal Medicine Current Accepting new patients
Dubois Regional Medical Center Internal Medicine CurrentSince Aug 22, 2011 Accepting new patients
Dubois Regional Medical Center CurrentSince Dec 1, 2015 Accepting new patients
Dubois Continuum of Care Community, Inc. Past Accepting new patients
Community Hospitalist of Pennsylvania Inc Internal Medicine Past Accepting new patients

Locations

100 Hospital Ave
Dubois, PA 15801
Phone (814) 375-2040

145 Hospital Ave
Ste 204
Dubois, PA 15801
Phone (814) 371-4360

145 Hospital Ave
Ste 101
Dubois, PA 15801
Phone (814) 375-5305

100 Hospital Ave
Ofc
Dubois, PA 15801

145 Hospital Ave
Ste 215
Dubois, PA 15801
Phone (814) 371-1717

Organizations & group practices 6

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

Hospital & facility affiliations 34

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

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445904000000",
    "number": "1073544375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 HOSPITAL AVE 215",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158011464",
            "telephone_number": "814-371-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 HOSPITAL AVE",
            "address_2": "SUITE 215",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158011462",
            "telephone_number": "814-371-1717",
            "fax_number": "814-375-4422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUK",
        "first_name": "STEPHEN",
        "middle_name": "M.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2015-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS-005395-L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001065654",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Du Bois, PA

Sources for this page

Verify at the official NPI Registry.