Individual provider Active NPI

John M Kukula, PA

  • Surgical Physician Assistant
  • Baltimore, MD
National Provider Identifier
1609805043
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
C0001010 Issued in MD
Practice address
301 Saint Paul PL
Surgical PA'S
Baltimore, MD 21202-2102
Phone
(410) 332-9265
NPI assigned
Jun 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C0001010 MD
Surgical Physician Assistant 363AS0400X C0001010 MD Primary

Addresses

Primary practice location

301 Saint Paul PL
Surgical PA'S
Baltimore, MD 21202-2102

Mailing address

PO Box 64075
Baltimore, MD 21264-4075

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20090929000630 MD Practitioner - Physician Assistant 0143366443 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Agnes Healthcare IncGroup PAC ID 9830092733, 265 clinicians

Practice addresses (Care Compare)

900 Caton Ave
Baltimore, MD 21229-5201
Phone (667) 234-6000

Hospital & facility affiliations

  • Saint Agnes Hospital Hospital, Baltimore, MD, CCN 210011

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C0001010MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Agnes Healthcare Inc CurrentSince Sep 25, 2015 Accepting new patients
Northwest Hospital Center, Inc Physician Assistant CurrentSince Sep 25, 2023 Accepting new patients
St Agnes Healthcare Inc Physician Assistant CurrentSince Sep 25, 2015 Accepting new patients
Sinai Hospital of Baltimore, Inc. CurrentSince Oct 30, 2010 Accepting new patients
Sinai Hospital of Baltimore Inc CurrentSince Oct 30, 2010 Accepting new patients
Northwest Hospital Center, Inc. Past Accepting new patients
Saint Joseph Medical Center , Inc. Past Accepting new patients

Locations

900 S Caton Ave
Baltimore, MD 21229
Phone (410) 368-3120

2411 W Belvedere Ave
Baltimore, MD 21215
Phone (410) 601-5700

5401 Old Court Rd
Randallstown, MD 21133
Phone (301) 337-2727

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1609805043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64075",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212644075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 SAINT PAUL PL",
            "address_2": "SURGICAL PA'S",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212022102",
            "telephone_number": "410-332-9265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUKULA",
        "first_name": "JOHN",
        "middle_name": "M",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0001010",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MD",
            "license": "C0001010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.