NPIMap

Individual provider Active NPI

Kale Quackenbush, DO

  • Family Medicine Physician
  • Covington, WA
National Provider Identifier
1578941522
Registry record updated Jun 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OL60572023 Issued in WA
Practice address
17700 SE 272ND St
Covington, WA 98042-4951
Phone
(253) 372-6500
NPI assigned
May 11, 2015
Last updated
Jun 8, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OL60572023 WA Primary

Addresses

Primary practice location

17700 SE 272ND St
Covington, WA 98042-4951

Mailing address

17700 SE 272ND St
Covington, WA 98042-4951
Phone (253) 372-6500

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
I20150824001286 WA Practitioner - Family Practice 7416262209 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

17700 SE 272ND St
Covington, WA 98042-4951
Phone (253) 372-7030

222 State Ave N
Kent, WA 98030-4544
Phone (253) 372-7788

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Oct 1, 2018 Accepting new patients
Multicare Health System Current Accepting new patients
Multicare Health System CurrentSince Oct 1, 2018 Accepting new patients
Multicare Health System Family Medicine Past Accepting new patients

Locations

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

17700 SE 272nd St
Kent, WA 98042
Phone (253) 372-6500

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

Interoperability endpoints

  • Direct secure messaging: kquackenbush205854@direct.multicare.org

Organizations & group practices 4

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 7

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": "1431302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591574400000",
    "number": "1578941522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17700 SE 272ND ST",
            "city": "COVINGTON",
            "state": "WA",
            "postal_code": "980424951",
            "telephone_number": "253-372-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17700 SE 272ND ST",
            "city": "COVINGTON",
            "state": "WA",
            "postal_code": "980424951",
            "telephone_number": "253-372-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUACKENBUSH",
        "first_name": "KALE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-11",
        "last_updated": "2020-06-08",
        "certification_date": "2020-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OL60572023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Covington, WA

Sources for this page

Verify at the official NPI Registry.