Active NPI
Micaiah Matthew Kuzma, MD
- Family Medicine Physician
- Keizer, OR
National Provider Identifier
1083799431
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 152066
- Practice address
- 5900 Inland Shores Way
Keizer, OR 97303 - Phone
- (503) 399-2424
- Fax
- (503) 589-6240
- NPI assigned
- Oct 26, 2006
- Last updated
- Apr 25, 2013
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 152066 | OR | Primary |
Addresses
Primary practice location
5900 Inland Shores Way
Keizer, OR 97303
Mailing address
2020 Capitol Street NE
Salem, OR 97301
Phone (503) 399-2424
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500624513 | Medicaid | OR | |
| P00866340 | Other | OR | RAILROAD MEDICARE |
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 |
|---|---|---|---|---|
| I20141022002697 | WA | Order and Referring Only - Family Practice | 1355467853 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frances Mahon Deaconess Hospital | Past | Accepting new patients |
Organizations & group practices 1
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.
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- Glasgow, MT
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366848000000",
"number": "1083799431",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2020 CAPITOL STREET NE",
"city": "SALEM",
"state": "OR",
"postal_code": "97301",
"telephone_number": "503-399-2424",
"fax_number": "503-589-6240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5900 INLAND SHORES WAY",
"city": "KEIZER",
"state": "OR",
"postal_code": "97303",
"telephone_number": "503-399-2424",
"fax_number": "503-589-6240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUZMA",
"first_name": "MICAIAH",
"middle_name": "MATTHEW",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-26",
"last_updated": "2013-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "152066",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500624513",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00866340",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Keizer, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2013; 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.