Individual provider Active NPI

Cyril Kulka, PA-C

  • Physician Assistant
  • Walnut Creek, CA
National Provider Identifier
1225166556
Registry record updated Jan 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA 17160 Issued in CA
Practice address
1425 S Main St
Walnut Creek, CA 94596-5318
Phone
(925) 295-4130
NPI assigned
Feb 28, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2022

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 PA 17160 CA Primary

Addresses

Primary practice location

1425 S Main St
Walnut Creek, CA 94596-5318

Mailing address

5117 Manila Ave
Oakland, CA 94618-1019
Phone (510) 655-1757

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20120202000278 CA Practitioner - Physician Assistant 9133386113 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

4501 Sand Creek Rd
Antioch, CA 94531-8687
Phone (925) 813-6500

901 Nevin Ave
Richmond, CA 94801-3143
Phone (510) 307-1500

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA 17160CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Permanente Medical Group, Inc CurrentSince Nov 12, 2011 Accepting new patients
Permanente Medical Group Inc CurrentSince Nov 12, 2011 Accepting new patients

Locations

4501 Sand Creek Rd
Antioch, CA 94531
Phone (925) 813-6420

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

1425 S Main St
Walnut Creek, CA 94596
Phone (925) 295-4130

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": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641168000000",
    "number": "1225166556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5117 MANILA AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946181019",
            "telephone_number": "510-655-1757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 S MAIN ST",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945965318",
            "telephone_number": "925-295-4130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KULKA",
        "first_name": "CYRIL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-28",
        "last_updated": "2022-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA 17160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4501 Sand Creek Rd",
            "city": "Antioch",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945318687",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Walnut Creek, CA

Sources for this page

Verify at the official NPI Registry.