Thomas Patrick Kuciejczyk-Kernan, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

R6J90 Issued in MO

Practice address

3930 S Broadway
Saint Louis, MO 63118-4626

Phone

(314) 898-1700

Fax

(314) 814-8542

NPI assigned

Jun 22, 2005

Last updated

Sep 1, 2016By the provider in NPPES

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 1

Other names 1

• Dr. Thomas Patrick Kernan Former name

Medicare fee-for-service enrollment

Enrolled in MO

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

Family Practice

Education

Saint Louis University School of Medicine, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Affinia HealthcareGroup PAC ID 1052386919, 28 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Affinia Healthcare

  • Federally Qualified Health Center (FQHC)
  • Saint Louis, MO
  • NPI 1902816077
  Medicare reassignment Care Compare group
• Affinia Healthcare

  • Federally Qualified Health Center (FQHC)
  • Saint Louis, MO
  • NPI 1013925890
  NPD (past)

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472688000000",
    "number": "1669478970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 BIDDLE ST",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631063454",
            "telephone_number": "314-898-1700",
            "fax_number": "314-814-8542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3930 S BROADWAY",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631184626",
            "telephone_number": "314-898-1700",
            "fax_number": "314-814-8542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUCIEJCZYK-KERNAN",
        "first_name": "THOMAS",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2016-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R6J90",
            "primary": true
        },
        {
            "code": "2084P0015X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychosomatic Medicine",
            "state": "MO",
            "license": "R6J90",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202710109",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THOMAS",
            "last_name": "KERNAN",
            "middle_name": "PATRICK",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Francis J Kubik III, DDS
• Rachael Danielle Kubik, RN, APRN, FNP-C
• Stephanie Kubik, DDS
• Amir Kucharski, MD, PHD
• Abigayle Kuchno, PHARMD
• Gabrielle A Kudrnka, CLC
• Joy Kuebee
• Richard J Kuebel, MD
• Colleen Kuehl, LPC
• Taylor June Kuehl, ATC, LAT

• Family Medicine Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; 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.