NPIMap

Individual provider Active NPI

Mathew Kummerfeldt, PA-C

  • Physician Assistant
  • Shelton, WA
National Provider Identifier
1285818815
Registry record updated Feb 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1701 N 13TH St
Shelton, WA 98584-2077
Phone
(360) 426-2653
Fax
(888) 985-0681
NPI assigned
Dec 18, 2007
Last updated
Feb 21, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2024

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 Primary

Addresses

Primary practice location

1701 N 13TH St
Shelton, WA 98584-2077

Mailing address

PO Box 1668
Shelton, WA 98584-5001
Phone (360) 426-2653

Other identifiers 7

IdentifierTypeStateIssuer
0273939OtherWAL&I
P00610661OtherWARAILROAD
8946032OtherWASTATE CRIME VICTIMS
0275126OtherWAL&I
8502049MedicaidWA
0228031OtherWASTATE L&I
0275142OtherWAL&I

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20080130000450 WA Practitioner - Physician Assistant 1456433481 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1812 N 13TH Loop Rd
Shelton, WA 98584-2169
Phone (360) 426-2653

2300 Kati CT
Shelton, WA 98584-1926

901 Mountain View Dr
Shelton, WA 98584-4401
Phone (360) 426-1611

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Grays Harbor County Public Hospital District No 1 CurrentSince May 23, 2021 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Mar 14, 2022 Accepting new patients
Public Hospital District No 1 of Mason County CurrentSince Sep 11, 2023 Accepting new patients
Public Hospital District No 1 of Mason County Wa CurrentSince Sep 11, 2023 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Mar 14, 2022 Accepting new patients
Public Hospital District No 1 of Mason County CurrentSince Jan 31, 2026 Accepting new patients
Grays Harbor County Public Hospital District No. 1 CurrentSince May 23, 2021 Accepting new patients

Locations

600 E Main St
Elma, WA 98541
Phone (360) 346-2222

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

1701 N 13th St
Shelton, WA 98584
Phone (360) 426-2653

1707 N 13th St
Shelton, WA 98584
Phone (360) 427-7333

1812 N 13th Loop Rd
Shelton, WA 98584
Phone (360) 426-2653

901 Mountain View Dr
Shelton, WA 98584
Phone (360) 426-1611

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

Interoperability endpoints

  • Direct secure messaging: mkummerfeldt4014747@ghc.direct-ci.net

Organizations & group practices 10

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 5

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": "1197936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708473600000",
    "number": "1285818815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1668",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985845001",
            "telephone_number": "360-426-2653",
            "fax_number": "888-985-0681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 N 13TH ST",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985842077",
            "telephone_number": "360-426-2653",
            "fax_number": "888-985-0681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUMMERFELDT",
        "first_name": "MATHEW",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-18",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "0273939",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00610661",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE CRIME VICTIMS",
            "identifier": "8946032",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "0275126",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8502049",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE L&I",
            "identifier": "0228031",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "0275142",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelton, WA

Sources for this page

Verify at the official NPI Registry.