Individual provider Active NPI

Kweku R Hutchful, MD

  • Pediatrics Physician
  • Las Vegas, NV
National Provider Identifier
1093782583
Registry record updated Feb 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
9189 Issued in NV
Practice address
4475 S Eastern Ave
Las Vegas, NV 89119-7826
Phone
(702) 669-5944
Fax
(702) 258-8542
NPI assigned
Mar 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 9189 NV Primary

Addresses

Primary practice location

4475 S Eastern Ave
Las Vegas, NV 89119-7826

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 669-5944

Other identifiers 3

IdentifierTypeStateIssuer
370022007OtherNVRAILROAD MEDICARE
2018508MedicaidNV
3102508MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20110404000105 NV Practitioner - Pediatric Medicine 9133303985 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Medical Associates, Inc CurrentSince Jan 18, 2011 Accepting new patients
Optum Medical Group Rhodes P C CurrentSince Jun 4, 2019 Accepting new patients
Optum Medical Group II Rhodes P C CurrentSince Jun 4, 2019 Accepting new patients
Spring Valley Medical Center Past Accepting new patients
Desert Springs Hospital Past Accepting new patients
Southwest Medical Associates Inc. Past Accepting new patients
University Medical Center of Southern Nevada Past Accepting new patients
Summerlin Hospital Medical Center L L C Past Accepting new patients
Centennial Hills Hospital Medical Center Past Accepting new patients

Locations

2704 N Tenaya Way
Las Vegas, NV 89128
Phone (702) 243-8500

653 N Town Center Dr
Ste 504
Las Vegas, NV 89144
Phone (702) 701-8400

2316 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 877-8330

420 N Nellis Blvd
Las Vegas, NV 89110
Phone (702) 339-5710

4475 S Eastern Ave
Las Vegas, NV 89119
Phone (702) 669-5811

Interoperability endpoints

  • Direct secure messaging: khutchful121342@westdirect.optum.com

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485907200000",
    "number": "1093782583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-669-5944",
            "fax_number": "702-258-8542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4475 S EASTERN AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891197826",
            "telephone_number": "702-669-5944",
            "fax_number": "702-258-8542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUTCHFUL",
        "first_name": "KWEKU",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-02",
        "last_updated": "2017-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NV",
            "license": "9189",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "370022007",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2018508",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3102508",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.