NPIMap

Individual provider Active NPI

Kyle Nathan Backer, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Longview, WA
National Provider Identifier
1487066841
Registry record updated Jun 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
MD61544789 Issued in WA
Practice address
1615 Delaware St
Longview, WA 98632-2367
Phone
(360) 636-8760
Fax
(360) 414-7599
NPI assigned
May 20, 2014
Last updated
Jun 6, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X A155221 CA
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X MD61544789 WA Primary

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

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
I20240620000768 WA Practitioner - Pathology 5698192110 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PeacehealthGroup PAC ID 5890689293, 188 clinicians
PeacehealthGroup PAC ID 9739092065, 101 clinicians

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

Merit-based Incentive Payment System (MIPS)

Final score
90.2 of 100Reported as group
Quality
84.35
Promoting interoperability
100
Improvement activities
40
Cost
79.93

Merit-based Incentive Payment System (MIPS)

Final score
94.42 of 100Reported as group
Quality
97.55
Promoting interoperability
100
Improvement activities
40
Cost
72.23

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A155221CAMDAnatomic Pathology & Clinical Pathology Physician
MD61544789WAMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Peacehealth CurrentSince Jul 5, 2024 Accepting new patients
Peacehealth CurrentSince Jul 5, 2024 Accepting new patients
Regents of the University of California CurrentSince Jul 19, 2020 Accepting new patients
Peacehealth CurrentSince Jul 5, 2024 Accepting new patients
Regents of the University of California Current Accepting new patients
Regents of the University of California Anatomic Pathology & Clinical Pathology CurrentSince Jul 19, 2020 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

3855 Health Sciences Dr
La Jolla, CA 92093
Phone (858) 822-6094

9444 Medical Center Dr
La Jolla, CA 92037
Phone (858) 249-1206

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5720

1615 Delaware St
Longview, WA 98632
Phone (360) 363-4818

400 NE Mother Joseph Pl
Vancouver, WA 98664
Phone (360) 514-2000

Interoperability endpoints

  • Direct secure messaging: kbacker660178@direct.peacehealth.org

Organizations & group practices 9

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 8

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": "1400544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1487066841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 232410",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921932410",
            "telephone_number": "800-926-8273",
            "fax_number": "888-539-8781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 DELAWARE ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322367",
            "telephone_number": "360-636-8760",
            "fax_number": "360-414-7599"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 W Arbor Dr",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921039000",
            "country_code": "US",
            "telephone_number": "205-599-4822",
            "fax_number": "800-926-8273",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 NE Mother Joseph Pl",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986643200",
            "country_code": "US",
            "telephone_number": "360-514-2116",
            "fax_number": "360-514-2416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BACKER",
        "first_name": "KYLE",
        "middle_name": "NATHAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-20",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "A155221",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "WA",
            "license": "MD61544789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, WA

Sources for this page

Verify at the official NPI Registry.