Individual provider Active NPI

David E Kautz, PAC

  • Physician Assistant
  • Paoli, PA
National Provider Identifier
1154394534
Registry record updated May 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA002780L Issued in PA
Practice address
255 W Lancaster Ave
Paoli, PA 19301
Phone
(610) 648-1043
Fax
(610) 648-1415
NPI assigned
Feb 8, 2006
Last updated
May 24, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA002780L PA Primary

Addresses

Primary practice location

255 W Lancaster Ave
Paoli, PA 19301

Mailing address

PO Box 3012
Wilmington, DE 19804
Phone (800) 456-4629

Other identifiers 1

IdentifierTypeStateIssuer
0704121MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081204000951 PA Practitioner - Physician Assistant 2365503679 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pennsylvania Urgent Care Centers, PLLCGroup PAC ID 8123200631, 107 clinicians

Practice addresses (Care Compare)

150 E Pennsylvania Ave
Downingtown, PA 19335-2657
Phone (610) 518-1060

2623 E Macdade Boulevard
Holmes, PA 19043-1317
Phone (267) 635-6060

2848 W Moreland Rd
Willow Grove, PA 19090-3051
Phone (267) 495-5455

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA002780LPAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Prospect Health Access Network, Inc. CurrentSince Jul 4, 2016 Accepting new patients
Emergency Care Services of Pennsylvania, P.C. Physician Assistant CurrentSince Jul 1, 2019 Accepting new patients
Prospect Health Access Network, Inc. CurrentSince Jul 4, 2016 Accepting new patients
Immediate Medical Care of Pennsylvania, LP PastSince Jun 1, 2008 Accepting new patients

Locations

1 Medical Center Blvd
Chester, PA 19013
Phone (610) 447-6666

1 Medical Center Blvd
Ste 301
Chester, PA 19013
Phone (610) 566-6744

1201 Langhorne Newtown Rd
Penndel, PA 19047
Phone (215) 710-2100

2601 Holme Ave
Philadelphia, PA 19152
Phone (215) 335-6000

100 W Sproul Rd
Ste 123
Springfield, PA 19064
Phone (610) 619-8281

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716508800000",
    "number": "1154394534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3012",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "19804",
            "telephone_number": "800-456-4629",
            "fax_number": "302-224-2848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 W LANCASTER AVE",
            "city": "PAOLI",
            "state": "PA",
            "postal_code": "19301",
            "telephone_number": "610-648-1043",
            "fax_number": "610-648-1415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAUTZ",
        "first_name": "DAVID",
        "middle_name": "E",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-08",
        "last_updated": "2024-05-24",
        "certification_date": "2024-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA002780L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0704121",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Paoli, PA

Sources for this page

Verify at the official NPI Registry.