Individual provider Active NPI

Keith Kulju

  • Gastroenterology Physician
  • Jamestown, NY
National Provider Identifier
1265471619
Registry record updated Jan 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
137830 Issued in NY
Practice address
15 S Main St
Suite 160
Jamestown, NY 14701-6626
Phone
(716) 484-7107
NPI assigned
Jun 4, 2006
Last updated
Jan 25, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 137830 NY Primary

Addresses

Primary practice location

15 S Main St
Suite 160
Jamestown, NY 14701-6626

Mailing address

15 S Main St
Suite 300
Jamestown, NY 14701-6626

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address keith.w.kulju@upmcdirect.com UPMC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20100331000096 NY Practitioner - GastroenterologyPractitioner - Internal Medicine 4284680596 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Other, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Great Lakes Physician Practice PCGroup PAC ID 6709007701, 143 clinicians

Practice addresses (Care Compare)

15 S Main St
Suite 160
Jamestown, NY 14701-6627
Phone (814) 484-7107

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy228
Upper gastrointestinal (GI) endoscopy for acid reflux190

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
137830NYMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Great Lakes Physician Practice PC Gastroenterology CurrentSince Jun 29, 2014 Accepting new patients

Locations

15 S Main St
Ste 160
Jamestown, NY 14701
Phone (716) 484-7107

15 S Main St
Ste 300
Jamestown, NY 14701
Phone (716) 488-1877

31 Sherman St
Ste 2400
Jamestown, NY 14701
Phone (814) 483-5306

Organizations & group practices 1

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.

Hospital & facility affiliations 4

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": "1149379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1265471619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 S MAIN ST",
            "address_2": "SUITE 300",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147016626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 S MAIN ST",
            "address_2": "SUITE 160",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147016626",
            "telephone_number": "716-484-7107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KULJU",
        "first_name": "KEITH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-04",
        "last_updated": "2024-01-25",
        "certification_date": "2021-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "137830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "keith.w.kulju@upmcdirect.com",
            "affiliation": "Y",
            "affiliationName": "UPMC",
            "address_1": "600 Grant St",
            "address_2": "Floor 58",
            "city": "Pittsburgh",
            "state": "PA",
            "country_code": "US",
            "postal_code": "152192702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jamestown, NY

Sources for this page

Verify at the official NPI Registry.