NPIMap

Individual provider Active NPI

Kellen Gumm, PA-C

  • Surgical Physician Assistant
  • Spokane, WA
National Provider Identifier
1598112211
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA60798666 Issued in WA
Practice address
122 W 7TH Ave Ste 110
Spokane, WA 99204-2301
Phone
(509) 456-0262
Fax
(509) 462-5059
NPI assigned
May 23, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Surgical Physician Assistant 363AS0400X PA60798666 WA Primary

Addresses

Primary practice location

122 W 7TH Ave Ste 110
Spokane, WA 99204-2301

Mailing address

605 E Holland Ave
Ste 112
Spokane, WA 99218-1246
Phone (509) 456-0262

Other practice location 1

4311 11th Ave NE
Suite 200
Seattle, WA 98105-6366
Phone (206) 616-4001

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
I20171013002067 WA Practitioner - Physician Assistant 2567737711 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spokane Emergency Care Physicians PLLCGroup PAC ID 0143554600, 68 clinicians

Practice addresses (Care Compare)

12606 E Mission Ave
Spokane Valley, WA 99216-3421
Phone (509) 473-5177

800 W 5TH Ave
Spokane, WA 99204-2803
Phone (509) 473-7101

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA60798666WAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Apr 16, 2019 Accepting new patients
Multicare Health System CurrentSince Apr 16, 2019 Accepting new patients
Kadlec Regional Medical Center Past Accepting new patients

Locations

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

605 E Holland Ave
Ste 112
Spokane, WA 99218
Phone (509) 342-3251

Interoperability endpoints

  • Direct secure messaging: kgumm847070@wm.providencedirect.org

Organizations & group practices 5

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 2

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": "1463961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1598112211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 E HOLLAND AVE",
            "address_2": "STE 112",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992181246",
            "telephone_number": "509-456-0262",
            "fax_number": "509-462-5059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 W 7TH AVE STE 110",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042301",
            "telephone_number": "509-456-0262",
            "fax_number": "509-462-5059"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4311 11th Ave NE",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981056366",
            "country_code": "US",
            "telephone_number": "206-616-4001",
            "fax_number": "206-616-3889",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUMM",
        "first_name": "KELLEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-23",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA60798666",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.