Individual provider Active NPI

Kevin Michael Watt, M.D.

  • Pediatric Critical Care Medicine Physician
  • Durham, NC
National Provider Identifier
1184899460
Registry record updated Nov 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
11371979-1205 Issued in UT
Practice address
Dumc
2301 Erwin Rd
Durham, NC 27710
Phone
(919) 684-8111
NPI assigned
Apr 28, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine Physician 2080P0203X 11371979-1205 UT Primary
Pediatrics Physician 208000000X 134974 NC

Addresses

Primary practice location

Dumc
2301 Erwin Rd
Durham, NC 27710

Mailing address

Dumc
2301 Erwin Rd
Durham, NC 27710
Phone (919) 684-8111

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address KWATT361728@DIRECT.MED.UTAH.EDU Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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
I20190903001851 UT Practitioner - Pediatric Medicine 4688830904 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
134974NCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Pediatric Acuity Care CurrentSince Aug 1, 2019 Accepting new patients
University of Utah Pediatric Acuity Care CurrentSince Aug 1, 2019 Accepting new patients
University of Utah Pediatric Acuity Care Pediatrics Current Accepting new patients

Locations

127 S 500 E
Salt Lake Cty, UT 84102

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

100 N Mario Capecchi Dr
Slc, UT 84113
Phone (801) 587-7109

Interoperability endpoints

  • Direct secure messaging: kwatt361728@direct.med.utah.edu

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1209340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637625600000",
    "number": "1184899460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DUMC",
            "address_2": "2301 ERWIN RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "27710",
            "telephone_number": "919-684-8111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "DUMC",
            "address_2": "2301 ERWIN RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "27710",
            "telephone_number": "919-684-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATT",
        "first_name": "KEVIN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-28",
        "last_updated": "2021-11-23",
        "certification_date": "2021-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "UT",
            "license": "11371979-1205",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "134974",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "KWATT361728@DIRECT.MED.UTAH.EDU",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

Verify at the official NPI Registry.