Individual provider Active NPI

Kieran Fredrick Kubac, MD

  • Internal Medicine Physician
  • Klamath Falls, OR
National Provider Identifier
1114487741
Registry record updated Mar 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD209470 Issued in OR
Practice address
2865 Daggett Ave
Klamath Falls, OR 97601-1106
Phone
(541) 274-6150
NPI assigned
Mar 20, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2024

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 MD209470 OR Primary

Addresses

Primary practice location

2865 Daggett Ave
Klamath Falls, OR 97601-1106

Mailing address

2865 Daggett Ave
Klamath Falls, OR 97601-1106
Phone (541) 882-6311

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20221012002223 OR Practitioner - Internal Medicine 0941537518 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2019
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)

2865 Daggett Ave
Klamath Falls, OR 97601-1106
Phone (541) 274-6221

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD209470ORMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sky Lakes Medical Center Inc CurrentSince Sep 1, 2022 Accepting new patients
Sky Lakes Medical Center Inc CurrentSince Sep 1, 2022 Accepting new patients

Locations

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

Interoperability endpoints

  • Direct secure messaging: kieran.kubac@hca3.eclinicaldirectplus.com

Organizations & group practices 2

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 2

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": "1553040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710979200000",
    "number": "1114487741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2865 DAGGETT AVE",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976011106",
            "telephone_number": "541-882-6311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2865 DAGGETT AVE",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976011106",
            "telephone_number": "541-274-6150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBAC",
        "first_name": "KIERAN",
        "middle_name": "FREDRICK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-20",
        "last_updated": "2024-03-21",
        "certification_date": "2023-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD209470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Klamath Falls, OR

Sources for this page

Verify at the official NPI Registry.