NPIMap

Individual provider Active NPI

Evan Loren Kulbacki, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Kingsport, TN
National Provider Identifier
1659531408
Registry record updated Sep 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
49647 Issued in TN
Practice address
130 W Ravine Rd
Kingsport, TN 37660-3837
Phone
(423) 224-6711
Fax
(423) 224-6717
NPI assigned
Jun 16, 2008
Last updated
Sep 8, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology (Pathology) Physician 207ZH0000X 49647 TN
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 49647 TN Primary

Addresses

Primary practice location

130 W Ravine Rd
Kingsport, TN 37660-3837

Mailing address

2175 Highway 75
Suite 4
Blountville, TN 37617
Phone (423) 323-5290

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20130626000155 TN Practitioner - Pathology 4880833771 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of Utah School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

130 W Ravine Rd
Kingsport, TN 37660-3837
Phone (423) 224-6700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
49647TNMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Highlands Pathology Consultants, P.C. Anatomic Pathology & Clinical Pathology CurrentSince Jul 15, 2013 Accepting new patients
Highlands Pathology Consultants, P.C. Anatomic Pathology & Clinical Pathology CurrentSince Jul 15, 2013 Accepting new patients

Locations

2175 Highway 75
Ste 4
Blountville, TN 37617

1 Medical Park Blvd
Bristol, TN 37620
Phone (423) 390-0451

130 W Ravine Rd
Kingsport, TN 37660
Phone (423) 224-3150

Organizations & group practices 2

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": "1213574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473292800000",
    "number": "1659531408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2175 HIGHWAY 75",
            "address_2": "SUITE 4",
            "city": "BLOUNTVILLE",
            "state": "TN",
            "postal_code": "37617",
            "telephone_number": "423-323-5290",
            "fax_number": "423-323-5653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 W RAVINE RD",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603837",
            "telephone_number": "423-224-6711",
            "fax_number": "423-224-6717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KULBACKI",
        "first_name": "EVAN",
        "middle_name": "LOREN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-16",
        "last_updated": "2016-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZH0000X",
            "taxonomy_group": "",
            "desc": "Pathology, Hematology",
            "state": "TN",
            "license": "49647",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "TN",
            "license": "49647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

Verify at the official NPI Registry.