Individual provider Active NPI

Roger T Kucway, MD

  • Radiation Oncology Physician
  • Monroe, MI
National Provider Identifier
1417049818
Registry record updated Feb 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
4301070053 Issued in MI
Practice address
800 Stewart Rd
Monroe, MI 48162-4226
Phone
(734) 240-1800
NPI assigned
Sep 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X 35.090157 OH
Radiation Oncology Physician 2085R0001X 4301070053 MI Primary

Addresses

Primary practice location

800 Stewart Rd
Monroe, MI 48162-4226

Mailing address

1 Seagate # 800
Toledo, OH 43604-1558
Phone (734) 240-1800

Other practice location 1

3000 Regency Ct
Ste 207
Toledo, OH 43623-3092
Phone (419) 471-0493

Other practice location 2

5300 Harroun Rd Ste 10
Sylvania, OH 43560-2146
Phone (419) 824-1952

Other identifiers 6

IdentifierTypeStateIssuer
P00422855OtherOHRR MEDICARE
5182210MedicaidMI
0N24000017OtherMIMEDICARE
2361386MedicaidOH
5201594OtherMIMI MEDICAID- OH LOCATIONS
P00639054OtherMIRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, OH2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20061017000255 MI Practitioner - Radiation Oncology 9436155306 Reassigns benefits to 2 organizations
I20070730000004 OH Practitioner - Radiation Oncology 9436155306 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Wayne State University School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Promedica Multi Specialty PhysiciansGroup PAC ID 7113182809, 269 clinicians

Practice addresses (Care Compare)

2142 N Cove Blvd
Toledo, OH 43606-3895
Phone (419) 291-1111

800 Stewart Rd
Monroe, MI 48162-4274
Phone (734) 240-1800

Hospital & facility affiliations

  • Promedica Monroe Regional Hospital Hospital, Monroe, MI, CCN 230099
  • Promedica Toledo Hospital Hospital, Toledo, OH, CCN 360068

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301070053MIMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians CurrentSince Jan 1, 2020 Accepting new patients
Promedica Central Physicians CurrentSince Jan 1, 2020 Accepting new patients
Toledo Radiation Oncology, Inc Radiation Oncology Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Northeastern Michigan Cancer Center Radiation Oncology Past Accepting new patients
Radiation Oncology Alliance Radiation Oncology Past Accepting new patients

Locations

777 Kimole Ln
Ste 250
Adrian, MI 49221
Phone (517) 265-3411

777 Kimole Ln
Adrian, MI 49221
Phone (517) 263-3393

777 Kimole Ln
Ste 130
Adrian, MI 49221
Phone (517) 265-0292

1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280

800 Stewart Rd
Monroe, MI 48162
Phone (734) 240-1800

718 N Macomb St
Monroe, MI 48162
Phone (734) 212-3097

800 Stewart Rd
Ste A
Monroe, MI 48162
Phone (734) 240-1800

2390 Enterprise St
Fremont, OH 43420
Phone (419) 461-1057

5805 Monclova Rd
Maumee, OH 43537
Phone (419) 824-1952

5300 Harroun Rd
Ste 10
Sylvania, OH 43560
Phone (419) 824-1952

5855 Monroe St
Sylvania, OH 43560
Phone (419) 291-2273

5300 Harroun Rd
Ste 118
Sylvania, OH 43560
Phone (419) 479-5386

2142 N Cove Blvd
Toledo, OH 43606
Phone (419) 291-1111

2109 Hughes Dr
Ste 450
Toledo, OH 43606
Phone (419) 251-3112

1 Seagate
#800
Toledo, OH 43604
Phone (567) 585-1964

1091 Pray Blvd
Waterville, OH 43566
Phone (419) 785-3282

Organizations & group practices 7

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.

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": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582502400000",
    "number": "1417049818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SEAGATE # 800",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041558",
            "telephone_number": "734-240-1800",
            "fax_number": "419-824-7359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 STEWART RD",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481624226",
            "telephone_number": "734-240-1800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3000 Regency Ct",
            "address_2": "Ste 207",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "436233092",
            "country_code": "US",
            "telephone_number": "419-471-0493",
            "fax_number": "419-474-0390",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5300 Harroun Rd Ste 10",
            "address_purpose": "LOCATION",
            "city": "Sylvania",
            "state": "OH",
            "postal_code": "435602146",
            "country_code": "US",
            "telephone_number": "419-824-1952",
            "fax_number": "419-824-0344",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUCWAY",
        "first_name": "ROGER",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2020-02-24",
        "certification_date": "2020-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "OH",
            "license": "35.090157",
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "MI",
            "license": "4301070053",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00422855",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5182210",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "0N24000017",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2361386",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI MEDICAID- OH LOCATIONS",
            "identifier": "5201594",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00639054",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, MI

Sources for this page

Verify at the official NPI Registry.