Individual provider Active NPI

Kelly R. Puster, M.D.

  • Surgery Physician
  • Elkhart, IN
National Provider Identifier
1669477881
Registry record updated Sep 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
01057142A Issued in IN
Practice address
303 S Nappanee St
Elkhart, IN 46514-2066
Phone
(574) 296-3220
Fax
(574) 296-3322
NPI assigned
Jun 15, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 01057142A IN Primary

Addresses

Primary practice location

303 S Nappanee St
Elkhart, IN 46514-2066

Mailing address

PO Box 2968
Elkhart, IN 46515-2968
Phone (574) 296-3220

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20191226001360 WA Practitioner - General Surgery 6507868882 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Iowa, RJ & L Carver College of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

311 S L St
Tacoma, WA 98405-3720

407 14TH Ave SE
Puyallup, WA 98372-3770
Phone (253) 697-1962

4700 Point Fosdick Dr
Gig Harbor, WA 98335-1706

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01057142AINMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of Washington Current Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Nov 18, 2019 Accepting new patients
Multicare Health System Current Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Nov 18, 2019 Accepting new patients
Multicare Health System CurrentSince May 11, 2020 Accepting new patients
Multicare Health System CurrentSince May 11, 2020 Accepting new patients
Multicare Health System Past Accepting new patients

Locations

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

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

700 Lilly Rd NE
Olympia, WA 98506
Phone (360) 923-7000

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

Interoperability endpoints

  • Direct secure messaging: kpuster482838@direct.multicare.org

Organizations & group practices 7

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": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190246400000",
    "number": "1669477881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2968",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465152968",
            "telephone_number": "574-296-3220",
            "fax_number": "574-296-3322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 S NAPPANEE ST",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465142066",
            "telephone_number": "574-296-3220",
            "fax_number": "574-296-3322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUSTER",
        "first_name": "KELLY",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-15",
        "last_updated": "2007-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01057142A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkhart, IN

Sources for this page

Verify at the official NPI Registry.