Kenneth P Perko, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD00014368 Issued in WA

Practice address

1740 Cooks Hill Rd
Centralia, WA 98531-9071

Phone

(360) 736-7623

Fax

(360) 736-4074

NPI assigned

Aug 26, 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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Cascade Family Medical Clinic Inc PS

  • Family Medicine Physician
  • Centralia, WA
  • NPI 1376536136
  NPD

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

{
    "created_epoch": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261008000000",
    "number": "1265425011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1740 COOKS HILL RD",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985319071",
            "telephone_number": "360-736-7623",
            "fax_number": "360-736-4074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 COOKS HILL RD",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985319071",
            "telephone_number": "360-736-7623",
            "fax_number": "360-736-4074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERKO",
        "first_name": "KENNETH",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-26",
        "last_updated": "2009-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00014368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8303802",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "0031982",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peach Pointe Adult Family Home LLC
• Angela Pearson
• Pediatric Rehabilitation Associates PLLC
• Allix Kaylyn Percival, AAC
• Briana Christine Perdue, PT
• Stephanie Rae Peruch
• Melissa R Peters, PT, DPT
• Brandy Michelle Peterson
• Kayla Marie Peterson
• Melissa E Peterson

• Family Medicine Physician in Centralia, WA
• Providers in Centralia, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.