Gene Michael Kubacki, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036098945 Issued in IL

Practice address

1029 East 130TH Street
Chicago, IL 60628

Phone

(773) 995-6300

Fax

(601) 376-2114

NPI assigned

Jan 4, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

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.

• Everside Health Fort Wayne-W Ludwig Rd

  • Primary Care Clinic/Center
  • Fort Wayne, IN
  • NPI 1861880890
  NPD (past)
• River Oaks Management Company LLC

  • Family Medicine Physician
  • Jackson, MS
  • NPI 1922029040
  NPD (past)

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576454400000",
    "number": "1275680258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2932 W LUDWIG RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468181328",
            "telephone_number": "260-755-1304",
            "fax_number": "260-755-1306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1029 EAST 130TH STREET",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60628",
            "telephone_number": "773-995-6300",
            "fax_number": "601-376-2114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBACKI",
        "first_name": "GENE",
        "middle_name": "MICHAEL",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "16884",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036098945",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04009076",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036098945",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madison Ku, DPT
• Morgan Ku, MD
• Paw Say Ku, LCPC
• Fei Li Kuang, M.D., PH.D.
• Run Rong Kuang
• Melissa Kubacki, MD
• Anne Elisabeth Kubal, PH.D.
• Jessica Kubasak, PT, DPT
• Kube Psychological Services LLC
• Erin Rose Kube, PHD

• Family Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.