Chelsea Catherine Kuckovic, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

61357051 Issued in WA

Practice address

15812 E Indiana Ave
Spokane Valley, WA 99216-1875

Phone

(509) 444-8200

NPI assigned

May 24, 2020

Last updated

Dec 10, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Health Association of SpokaneGroup PAC ID 9638063217, 222 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: chelsea.kuckovic.1@11411.direct.athenahealth.com
• Direct secure messaging: croughsedge2547826@wm.providencedirect.org

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.

• Community Health Association of Spokane

  • Federally Qualified Health Center (FQHC)
  • Spokane, WA
  • NPI 1326005851
  Medicare reassignment Care Compare group NPD (past)
• Community Health Association of Spokane

  • Federally Qualified Health Center (FQHC)
  • Spokane, WA
  • NPI 1295946101
  NPD
• Community Health Association of Spokane

  • Federally Qualified Health Center (FQHC)
  • Spokane, WA
  • NPI 1679363592
  NPD

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

{
    "created_epoch": "1590278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733788800000",
    "number": "1174146245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 N IRON BRIDGE WAY",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992024932",
            "telephone_number": "509-444-8888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15812 E INDIANA AVE",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992161875",
            "telephone_number": "509-444-8200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Nicholis Street",
            "address_purpose": "LOCATION",
            "city": "Davenport",
            "state": "WA",
            "postal_code": "991229729",
            "country_code": "US",
            "telephone_number": "509-725-7501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUCKOVIC",
        "first_name": "CHELSEA",
        "middle_name": "CATHERINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-24",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "61357051",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Falko F Kriel, EAMP, L.AC
• Kaylene Ann Kristofferson
• Amanda Elise Krueger, DPT
• Kassidy Krug, OT
• Jeffrey R Kruse, LMP
• Karen A. Kuehn, ARNP
• Erin Marie Kuh, RD
• Chante Hokualakawenaokeao Kuloloio
• Jordan Kunkel
• Marina Afanasevna Kvasov, L.M.P.

• Physician Assistant in Spokane Valley, WA
• Providers in Spokane Valley, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; 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.