Individual provider Active NPI

Anna Kulacz-McNett, PA-C

  • Physician Assistant
  • Sutherlin, OR
National Provider Identifier
1528436656
Registry record updated Sep 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
123 Ponderosa Dr
Sutherlin, OR 97479-9812
Phone
(541) 459-3788
NPI assigned
Sep 6, 2015
Last updated
Sep 26, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2023

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 NU Primary

Addresses

Primary practice location

123 Ponderosa Dr
Sutherlin, OR 97479-9812

Mailing address

150 NE Kenneth Ford Dr
Roseburg, OR 97470-1042
Phone (541) 672-9596

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151117001127 OR Practitioner - Physician Assistant 8123338464 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

20170 N Umpqua Hwy
Glide, OR 97443-9620
Phone (541) 496-3504

775 Taylor Rd
Sutherlin, OR 97479-8000
Phone (541) 672-9596

790 S Main St
Myrtle Creek, OR 97457-9303
Phone (541) 860-4070

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Umpqua Community Health Center, Inc. CurrentSince Nov 2, 2015 Accepting new patients
Umpqua Community Health Center, Inc. CurrentSince Nov 2, 2015 Accepting new patients

Locations

150 NE Kenneth Ford Dr
Roseburg, OR 97470

123 Ponderosa Dr
Sutherlin, OR 97479
Phone (541) 459-3788

775 Taylor Rd
Sutherlin, OR 97479
Phone (541) 492-2087

Interoperability endpoints

  • Direct secure messaging: anna.kulacz.1@17792.direct.athenahealth.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.

Hospital & facility affiliations 1

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": "1441497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695686400000",
    "number": "1528436656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 NE KENNETH FORD DR",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974701042",
            "telephone_number": "541-672-9596",
            "fax_number": "541-492-2060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 PONDEROSA DR",
            "city": "SUTHERLIN",
            "state": "OR",
            "postal_code": "974799812",
            "telephone_number": "541-459-3788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KULACZ-MCNETT",
        "first_name": "ANNA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-06",
        "last_updated": "2023-09-26",
        "certification_date": "2023-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sutherlin, OR

Sources for this page

Verify at the official NPI Registry.