Kyle Nathan Backer, M.D.
Individual provider Active NPI Anatomic Pathology & Clinical Pathology Physician · Longview, WA
NPI 1487066841 · NPPES record last updated Jun 6, 2024
Key facts
- NPI
- 1487066841
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician 207ZP0102X
- License
- MD61544789 (WA)
- Practice address
- 1615 Delaware St
Longview, WA 98632-2367 - Phone
- (360) 636-8760
- Fax
- (360) 414-7599
- NPI assigned
- May 20, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 16
Hospital & facility affiliations 8
Medicare Care Compare profile
- Specialty
- Pathology
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Peacehealth
Peacehealth
Practice addresses (Care Compare)
1615 Delaware St
Longview, WA 98632-2367
Phone (360) 636-4814
400 NE Mother Joseph PL
Vancouver, WA 98664-3200
Phone (360) 514-1734
Hospital & facility affiliations
- Peacehealth Southwest Medical Cente
- Columbia Memorial Hospital
- Peacehealth St John Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 90.2 of 100
- Quality
- 84.35
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 79.93
Merit-based Incentive Payment System (MIPS)
- Final score
- 94.42 of 100
- Quality
- 97.55
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 72.23
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240620000768 | WA | Practitioner - Pathology | 5698192110 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A155221 | CA | MD | Anatomic Pathology & Clinical Pathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Regents of the University of California | Current | Accepting new patients | |
| Peacehealth | Current |
Accepting new patients | |
| Peacehealth | Current |
Accepting new patients | |
| Regents of the University of California | Anatomic Pathology & Clinical Pathology | Current |
Accepting new patients |
| Regents of the University of California | Current |
Accepting new patients | |
| Peacehealth | Current |
Accepting new patients | |
| Baptist Health System, Inc. | Past | Accepting new patients | |
| Regents of the University of California Ucsd Head and Neck Surgery | Past | Accepting new patients | |
| Baptist Health System, Inc. | Past | Accepting new patients |
Locations
9444 Medical Center Dr
La Jolla, CA 92037
Phone (858) 249-1206
3855 Health Sciences Dr
La Jolla, CA 92093
Phone (858) 822-6094
200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754
1615 Delaware St
Longview, WA 98632
Phone (360) 363-4818
400 NE Mother Joseph Pl
Vancouver, WA 98664
Phone (360) 514-2000
Interoperability endpoints
- kbacker660178@direct.peacehealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | A155221 | CA | |
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | MD61544789 | WA | Yes |
Addresses
Primary practice location
1615 Delaware St
Longview, WA 98632-2367
Mailing address
PO Box 232410
San Diego, CA 92193-2410
Phone (800) 926-8273
Other practice location 1
200 W Arbor Dr
San Diego, CA 92103-9000
Phone (205) 599-4822
Other practice location 2
400 NE Mother Joseph Pl
Vancouver, WA 98664-3200
Phone (360) 514-2116
Other providers in Longview, WA
- Ava Inc.
- Alison Kathleen Ave Lallemant
- Awakenings
- Robert C Axelrod
- Anita Louise Bach
- Hanna Badger
- Sholeh Bagheri
- Suhail Bahu
- Kelly Baierl
- Gerry Lee Bailey
All providers in Longview, WA · Anatomic Pathology & Clinical Pathology Physician in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 6, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.