NPIMap

Individual provider Active NPI

Kevin Michael Anderson Lutley, MD

  • Internal Medicine Physician
  • Stanford, CA
National Provider Identifier
1194221036
Registry record updated Apr 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A163773 Issued in CA
Practice address
300 Pasteur Dr
Stanford, CA 94305-2200
Phone
(650) 723-4000
NPI assigned
Mar 31, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 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 A163773 CA Primary

Addresses

Primary practice location

300 Pasteur Dr
Stanford, CA 94305-2200

Mailing address

300 Pasteur Dr
Stanford, CA 94305-2200
Phone (650) 723-4000

Other practice location 1

211 Quarry Rd Ste 302
Palo Alto, CA 94304-1416
Phone (650) 498-9000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210825002725 CA Practitioner - Internal Medicine 3476958695 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Michigan State University College of Human Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Stanford Health CareGroup PAC ID 6709797491, 3,152 clinicians

Practice addresses (Care Compare)

300 Pasteur Dr
Stanford, CA 94305-2200
Phone (650) 723-4000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A163773CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Stanford Health Care CurrentSince Aug 18, 2021 Accepting new patients
Stanford Health Care Internal Medicine CurrentSince Aug 18, 2021 Accepting new patients
Lucile Salter Packard Children's Hospital at Stanford Past Accepting new patients
Stanford Hospital and Clinics Past Accepting new patients

Locations

7999 Gateway Blvd
Ste 200
Newark, CA 94560
Phone (510) 806-2947

211 Quarry Rd
Palo Alto, CA 94304
Phone (650) 498-9000

211 Quarry Rd
Ste 302
Palo Alto, CA 94304
Phone (650) 498-9000

300 Pasteur Dr
#154
Stanford, CA 94305

300 Pasteur Dr
Stanford, CA 94305
Phone (650) 498-5710

Interoperability endpoints

  • Direct secure messaging: klutley215875@direct.stanfordhealthcare.org

Organizations & group practices 4

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.

Hospital & facility affiliations 8

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": "1522454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713484800000",
    "number": "1194221036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR",
            "city": "STANFORD",
            "state": "CA",
            "postal_code": "943052200",
            "telephone_number": "650-723-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR",
            "city": "STANFORD",
            "state": "CA",
            "postal_code": "943052200",
            "telephone_number": "650-723-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "211 Quarry Rd Ste 302",
            "address_purpose": "LOCATION",
            "city": "Palo Alto",
            "state": "CA",
            "postal_code": "943041416",
            "country_code": "US",
            "telephone_number": "650-498-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUTLEY",
        "first_name": "KEVIN",
        "middle_name": "MICHAEL ANDERSON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-31",
        "last_updated": "2024-04-19",
        "certification_date": "2024-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A163773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stanford, CA

Sources for this page

Verify at the official NPI Registry.