NPIMap

Individual provider Active NPI

George Kubac, M.D.

  • Interventional Cardiology Physician
  • Klamath Falls, OR
National Provider Identifier
1114081700
Registry record updated Nov 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
MD20381 Issued in OR
Practice address
3001 Daggett Ave Ste 101
Klamath Falls, OR 97601-1126
Phone
(541) 884-6233
Fax
(541) 880-2840
NPI assigned
Dec 20, 2006
Last updated
Nov 4, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology Physician 207RI0011X MD20381 OR Primary

Addresses

Primary practice location

3001 Daggett Ave Ste 101
Klamath Falls, OR 97601-1126

Mailing address

PO Box 2120
Portland, OR 97208-2120
Phone (541) 884-6233

Other identifiers 3

IdentifierTypeStateIssuer
060060517OtherRAILROAD MEDICARE
164981MedicaidOR
060051986OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20040326000889 OR Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 0042109688 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sky Lakes Medical Center IncGroup PAC ID 1052204096, 196 clinicians

Practice addresses (Care Compare)

3001 Daggett Ave
Suite 101
Klamath Falls, OR 97601-1126
Phone (541) 274-8930

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10
Pacemaker insertion or repair1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sky Lakes Medical Center Inc CurrentSince Jun 1, 2003 Accepting new patients
George Kubac MD PC Interventional Cardiology CurrentSince Jul 5, 2000 Accepting new patients
Sky Lakes Medical Center Inc CurrentSince Jun 1, 2003 Accepting new patients

Locations

2614 Clover St
Klamath Falls, OR 97601
Phone (503) 894-8122

2865 Daggett Ave
Klamath Falls, OR 97601
Phone (541) 833-6221

3001 Daggett Ave
Ste 101
Klamath Falls, OR 97601
Phone (541) 274-3278

Organizations & group practices 3

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667520000000",
    "number": "1114081700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2120",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972082120",
            "telephone_number": "541-884-6233",
            "fax_number": "541-880-2840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 DAGGETT AVE STE 101",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976011126",
            "telephone_number": "541-884-6233",
            "fax_number": "541-880-2840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBAC",
        "first_name": "GEORGE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-20",
        "last_updated": "2022-11-04",
        "certification_date": "2022-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "OR",
            "license": "MD20381",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "060060517",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164981",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "060051986",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Klamath Falls, OR

Sources for this page

Verify at the official NPI Registry.