Active NPI
Jeremy Kulchuk
- Medical Physician Assistant
- Charleston, WV
National Provider Identifier
1386042984
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 660
- Practice address
- 3200 Maccorkle Ave SE
Charleston, WV 25304-1227 - Phone
- (304) 388-4172
- NPI assigned
- Dec 12, 2014
- Last updated
- Jun 10, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 660 | WV | Primary |
Addresses
Primary practice location
3200 Maccorkle Ave SE
Charleston, WV 25304-1227
Mailing address
34 Chester Dr Apt 202
Scott Depot, WV 25560-5608
Phone (304) 687-3805
Other practice location 1
563 State Route 34
Hurricane, WV 25526-7000
Phone (304) 757-5063
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 660 | WV | MD | Psychologist |
Interoperability endpoints
- jkulchuk20822@gohealthupmc.direct-ci.com
Organizations & group practices 2
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.
-
- Emergency Medicine Physician
- Gassaway, WV
- NPI 1568401461
-
- Urgent Care Clinic/Center
- South Charleston, WV
- NPI 1912133315
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1418342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717977600000",
"number": "1386042984",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34 CHESTER DR APT 202",
"city": "SCOTT DEPOT",
"state": "WV",
"postal_code": "255605608",
"telephone_number": "304-687-3805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 MACCORKLE AVE SE",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253041227",
"telephone_number": "304-388-4172"
}
],
"practiceLocations": [
{
"address_1": "563 State Route 34",
"address_purpose": "LOCATION",
"city": "Hurricane",
"state": "WV",
"postal_code": "255267000",
"country_code": "US",
"telephone_number": "304-757-5063",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KULCHUK",
"first_name": "JEREMY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-12-12",
"last_updated": "2024-06-10",
"certification_date": "2024-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "WV",
"license": "660",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; 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.