Walter Takeshi Kusumoto, M.D. M.P.H.

Primary specialty

Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X

License

A60788 Issued in CA

Practice address

1645 Esplanade
Suite 3
Chico, CA 95926-3367

Phone

(530) 893-8806

Fax

(530) 893-8846

NPI assigned

May 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 6

Other names 1

• Dr. Walter T. Kusumoto Professional name

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Cardiac Electrophysiology

Education

Saint Louis University School of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Enloe Health Hospital, Chico, CA, CCN 050039

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: wkusumoto15309@enloedirect.org

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.

• Arrhythmia Center of Northern California, Inc.

  • Clinical Cardiac Electrophysiology Physician
  • Chico, CA
  • NPI 1952754673

  Cardiovascular Disease

  Medicare reassignment NPD
• Enloe Medical Center

  • General Acute Care Hospital
  • Chico, CA
  • NPI 1417901091
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Enloe Medical Center

  • General Acute Care Hospital
  • Chico, CA
  • NPI 1417901091
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693353600000",
    "number": "1619935079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1645 ESPLANADE STE 3",
            "city": "CHICO",
            "state": "CA",
            "postal_code": "959263367",
            "telephone_number": "530-893-8806",
            "fax_number": "530-893-8846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 ESPLANADE",
            "address_2": "SUITE 3",
            "city": "CHICO",
            "state": "CA",
            "postal_code": "959263367",
            "telephone_number": "530-893-8806",
            "fax_number": "530-893-8846"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1145 Whiskeytown Ct Ste A",
            "address_purpose": "LOCATION",
            "city": "Redding",
            "state": "CA",
            "postal_code": "960010227",
            "country_code": "US",
            "telephone_number": "530-893-8806",
            "fax_number": "530-893-8846",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUSUMOTO",
        "first_name": "WALTER",
        "middle_name": "TAKESHI",
        "name_prefix": "Dr.",
        "credential": "M.D. M.P.H.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "CA",
            "license": "A60788",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "CA",
            "license": "A60788",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL BOARD OF CALIFORNIA - CALIFORNIA MEDICAL LICENSE",
            "identifier": "A60788",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1619935079",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CENTERS FOR MEDICARE & MEDICADE SERVICES (CMS): MEDICARE ID",
            "identifier": "00A607880",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "00A607880",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEA",
            "identifier": "BK5138169",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL BOARD OF CALIFORNIA--FICTICIOUS NAME PERMIT (FNP)",
            "identifier": "FNP 41401",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WALTER",
            "last_name": "KUSUMOTO",
            "middle_name": "T.",
            "prefix": "DR.",
            "credential": "M.D. M.P.H.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Clinical Cardiac Electrophysiology Physician in Chico, CA
• Providers in Chico, CA by specialty
• Clinical Cardiac Electrophysiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.