Kevin Richard Kracke, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY189 Issued in ID

Practice address

422 17TH St
Lewiston, ID 83501-2526

Phone

(208) 743-4680

Fax

(208) 743-1756

NPI assigned

Sep 9, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Dr Kracke and Associates P aGroup PAC ID 1951206796, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Dr. Kracke and Associates P a

  • Mental Health Counselor
  • Lewiston, ID
  • NPI 1851448781
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363305600000",
    "number": "1164416749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2145",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835011465",
            "telephone_number": "208-743-4680",
            "fax_number": "208-743-1756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "422 17TH ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012526",
            "telephone_number": "208-743-4680",
            "fax_number": "208-743-1756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRACKE",
        "first_name": "KEVIN",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-09",
        "last_updated": "2013-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "ID",
            "license": "PSY189",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "N4478",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUESHIELD OF IDAHO",
            "identifier": "000010015963",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806177700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie Knittel
• Gerald L Knouf, MD
• Todd Kolb, RPH
• Kristopher John Konen, HI/BI
• Diana L Kottkey, NP
• Matthew George Krahn, CRNA
• Elzbieta E Kraszewska-Ostromecka, MD
• Amanda Kreienheder I
• Theodore K Krisher, MD
• Kristy Kuehfuss, PHD, PLLC

• Psychologist in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Psychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.