NPIMap

Individual provider Active NPI

John Kuckelman

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Joint Base Lewis McChord, WA
National Provider Identifier
1669882304
Registry record updated May 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
DO.OP.61502437-IMLC Issued in WA
Practice address
9040 Jackson Ave
Joint Base Lewis McChord, WA 98431-1000
Phone
(253) 968-1110
NPI assigned
May 3, 2014
Last updated
May 17, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 92772 GA
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X DO.OP.61502437-IMLC WA Primary

Addresses

Primary practice location

9040 Jackson Ave
Joint Base Lewis McChord, WA 98431-1000

Mailing address

9040 Jackson Ave
Tacoma, WA 98431-0001
Phone (253) 968-1110

Other practice location 1

9040 Fitzsimmons Dr
Joint Base Lewis McChord, WA 98431-1000
Phone (253) 968-0236

Other practice location 2

1120 15th St
Augusta, GA 30912-1000
Phone (706) 721-8623

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, WA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220812000705 GA Practitioner - Thoracic Surgery 0941516066 Reassigns benefits to 2 organizations
I20241003001938 WA Practitioner - Thoracic SurgeryPractitioner - General Surgery 0941516066 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Thoracic SurgeryAlso: General Surgery
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians

Practice addresses (Care Compare)

1802 Yakima Ave
Suite 102
Tacoma, WA 98405-5303
Phone (253) 272-7777

413 Lilly Rd NE
Olympia, WA 98506-5133
Phone (360) 493-4083

525 Lilly Rd NE
Olympia, WA 98506-5101

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
92772GAMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
DO.OP.61502437-IMLCWAMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Jan 23, 2025 Accepting new patients
Franciscan Medical Group Current Accepting new patients
Au Medical Associates Inc CurrentSince Aug 5, 2022 Accepting new patients
Franciscan Medical Group Thoracic Surgery (Cardiothoracic Vascular Surgery) CurrentSince Oct 14, 2024 Accepting new patients
Providence Health & Services Washington CurrentSince Sep 1, 2024 Accepting new patients
Franciscan Medical Group CurrentSince Oct 14, 2024 Accepting new patients
Multicare Health System CurrentSince Jan 23, 2025 Accepting new patients
Phoebe Physician Group, Inc CurrentSince Jul 1, 2023 Accepting new patients
Multicare Health System Current Accepting new patients
Au Medical Associates Inc CurrentSince Aug 5, 2022 Accepting new patients
Providence Health & Services Washington Past Accepting new patients

Locations

2002 Palmyra Rd
Ste 201
Albany, GA 31701
Phone (229) 312-5802

417 W 3rd Ave
Albany, GA 31701
Phone (229) 317-2207

151 Mayo St
Ste B
Americus, GA 31709
Phone (229) 928-2900

1120 15th St
Augusta, GA 30912
Phone (706) 721-3873

1120 15th St
#6000
Augusta, GA 30912
Phone (706) 721-3813

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

1018 Capitol Way S
Ste 300
Olympia, WA 98501
Phone (360) 486-6508

525 Lilly Rd NE
Olympia, WA 98506
Phone (360) 413-8550

1950 NW Myhre Rd
Silverdale, WA 98383
Phone (560) 240-4000

1802 Yakima Ave
Ste 102
Tacoma, WA 98405
Phone (253) 272-7777

1812 S J St
Ste 120
Tacoma, WA 98405
Phone (253) 428-2200

Organizations & group practices 12

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 6

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": "1399075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715904000000",
    "number": "1669882304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9040 JACKSON AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984310001",
            "telephone_number": "253-968-1110",
            "fax_number": "253-968-3219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9040 JACKSON AVE",
            "city": "JOINT BASE LEWIS MCCHORD",
            "state": "WA",
            "postal_code": "984311000",
            "telephone_number": "253-968-1110"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9040 Fitzsimmons Dr",
            "address_purpose": "LOCATION",
            "city": "Joint Base Lewis McChord",
            "state": "WA",
            "postal_code": "984311000",
            "country_code": "US",
            "telephone_number": "253-968-0236",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1120 15th St",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309121000",
            "country_code": "US",
            "telephone_number": "706-721-8623",
            "fax_number": "706-721-1459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUCKELMAN",
        "first_name": "JOHN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-03",
        "last_updated": "2024-05-17",
        "certification_date": "2024-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "GA",
            "license": "92772",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "WA",
            "license": "DO.OP.61502437-IMLC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joint Base Lewis McChord, WA

Sources for this page

Verify at the official NPI Registry.