Individual provider Active NPI

Kevin Richard Kruse, MD

  • Cardiovascular Disease Physician
  • Concord, NC
National Provider Identifier
1609872811
Registry record updated Dec 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
9600141 Issued in NC
Practice address
100 Medical Park Dr
Ste 210
Concord, NC 28025-2948
Phone
(704) 403-6100
NPI assigned
Jun 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 9600141 NC
Interventional Cardiology Physician 207RI0011X 9600141 NC
Cardiovascular Disease Physician 207RC0000X 9600141 NC Primary

Addresses

Primary practice location

100 Medical Park Dr
Ste 210
Concord, NC 28025-2948

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

1237 Harding Pl
Ste 3100
Charlotte, NC 28204
Phone (704) 373-0212

Other practice location 2

134 Medical Park Rd
Ste 111 - Adult Cardiology
Mooresville, NC 28117-8526
Phone (704) 801-9100

Other practice location 3

101 E W T Harris Blvd
Ste 1213
Charlotte, NC 28262-3485
Phone (704) 863-1950

Other practice location 4

447 McAlister Rd
Ste 3200
Lincolnton, NC 28092-4114
Phone (980) 212-6300

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kkruse128644@CarolinasHealthcareSystem.direct-ci.com Atrium Health
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070713000653 NC Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 7810926136 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology), Internal Medicine
Education
Ohio State University College of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Carolinas Physicians Network IncGroup PAC ID 3375449655, 2,324 clinicians

Practice addresses (Care Compare)

1550 Faulk St
Suite 3100
Monroe, NC 28112-5197
Phone (704) 667-3410

Hospital & facility affiliations

  • Atrium Health Cleveland Hospital, Shelby, NC, CCN 340021
  • Carolinas Medical Center/Behav Health Hospital, Charlotte, NC, CCN 340113

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9600141NCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Physicians Network Inc Cardiovascular Disease CurrentSince Sep 1, 2010 Accepting new patients
Carolinas Physicians Network Inc Cardiovascular Disease Current Accepting new patients
Carolinas Physicians Network Inc CurrentSince Sep 1, 2010 Accepting new patients
Carolinas Physicians Network, Inc Past Accepting new patients
Heart Group of the Carolinas PastSince Aug 1, 2005 Accepting new patients

Locations

100 N 6th St
Ste 900A
Minneapolis, MN 55403

15110 John J Delaney Dr
Ste 200
Charlotte, NC 28277
Phone (704) 302-8100

101 E Wt Harris Blvd
Ste 1213
Charlotte, NC 28262
Phone (704) 863-1950

1237 Harding Pl
Ste 3100
Charlotte, NC 28204

920 Church St N
Concord, NC 28025
Phone (704) 403-3000

100 Medical Park Dr
Ste 210
Concord, NC 28025
Phone (704) 403-6100

2680 Aberdeen Blvd
Gastonia, NC 28054
Phone (704) 446-3222

447 McAlister Rd
Ste 3200
Lincolnton, NC 28092
Phone (980) 212-6300

1550 Faulk St
Ste 3100
Monroe, NC 28112
Phone (704) 667-3410

134 Medical Park Rd
Ste 111
Mooresville, NC 28117
Phone (704) 801-9100

8560 Cook St
Mt Pleasant, NC 28124
Phone (704) 403-1911

Interoperability endpoints

  • Direct secure messaging: kkruse128644@carolinashealthcaresystem.direct-ci.com

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 and National Provider Directory roles.

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": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703548800000",
    "number": "1609872811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEDICAL PARK DR",
            "address_2": "STE 210",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252948",
            "telephone_number": "704-403-6100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1237 Harding Pl",
            "address_2": "Ste 3100",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "28204",
            "country_code": "US",
            "telephone_number": "704-373-0212",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "134 Medical Park Rd",
            "address_2": "Ste 111 - Adult Cardiology",
            "address_purpose": "LOCATION",
            "city": "Mooresville",
            "state": "NC",
            "postal_code": "281178526",
            "country_code": "US",
            "telephone_number": "704-801-9100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 E W T Harris Blvd",
            "address_2": "Ste 1213",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282623485",
            "country_code": "US",
            "telephone_number": "704-863-1950",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "447 McAlister Rd",
            "address_2": "STE 3200",
            "address_purpose": "LOCATION",
            "city": "Lincolnton",
            "state": "NC",
            "postal_code": "280924114",
            "country_code": "US",
            "telephone_number": "980-212-6300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRUSE",
        "first_name": "KEVIN",
        "middle_name": "RICHARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2023-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "9600141",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NC",
            "license": "9600141",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NC",
            "license": "9600141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kkruse128644@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "100 Medical Park Dr",
            "address_2": "Ste 210",
            "city": "Concord",
            "state": "NC",
            "country_code": "US",
            "postal_code": "280252948",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

Verify at the official NPI Registry.