NPIMap

Individual provider Active NPI

Annie Kavulich

  • Physician Assistant
  • Easton, PA
National Provider Identifier
1679028013
Registry record updated Dec 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA058359 Issued in PA
Practice address
1600 St Lukes Blvd
Easton, PA 18045-5671
Phone
(908) 847-2830
NPI assigned
Aug 15, 2016
Last updated
Dec 30, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA058359 PA Primary

Addresses

Primary practice location

1600 St Lukes Blvd
Easton, PA 18045-5671

Mailing address

1600 St Lukes Blvd
Easton, PA 18045-5671
Phone (908) 847-2830

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 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
I20160914002740 PA Practitioner - Physician Assistant 4587950779 Reassigns benefits to 2 organizations
I20231215000286 NJ Practitioner - Physician Assistant 4587950779 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Lukes Physician Group IncGroup PAC ID 6709798333, 2,161 clinicians

Practice addresses (Care Compare)

123 A Roseberry St
Phillipsburg, NJ 08865-1629
Phone (908) 847-8853

123 Roseberry St
Phillipsburg, NJ 08865-1629
Phone (908) 454-0370

1600 St Lukes Blvd
Easton, PA 18045-5671

1736 Hamilton St
Allentown, PA 18104-5656
Phone (484) 526-8142

1736 W Hamilton St
Allentown, PA 18104-5656
Phone (610) 954-3571

185 Roseberry St
Phillipsburg, NJ 08865-1690
Phone (908) 847-3212

250 S 21St St
Easton, PA 18042-3851

279 State Route 31 S
Washington, NJ 07882-4098
Phone (484) 503-7546

801 Ostrm St
Bethlehem, PA 18015-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.13 of 100Reported as apm
Quality
82.27
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
97.13 of 100Reported as apm
Quality
82.27
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA058359PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St. Luke's Warren Physician Group, PC CurrentSince Dec 18, 2023 Accepting new patients
St. Luke's Warren Physician Group, PC CurrentSince Dec 18, 2023 Accepting new patients
St Luke's Physician Group Inc CurrentSince Mar 11, 2024 Accepting new patients
St. Luke's Physician Group, Inc. CurrentSince Mar 11, 2024 Accepting new patients
St. Luke's Physician Group, Inc. Past Accepting new patients

Locations

185 Roseberry St
Bldg 2ND
Phillipsburg, NJ 08865
Phone (908) 847-2619

279 State Route 31 S
Washington, NJ 07882
Phone (908) 689-2201

315 State Route 31 S
Washington, NJ 07882
Phone (908) 689-0777

1600 St Lukes Blvd
Easton, PA 18045
Phone (484) 503-4400

801 Ostrum St
Fountain Hill, PA 18015
Phone (610) 954-2200

Interoperability endpoints

  • Direct secure messaging: annie.kavulich@slpg.direct-sluhn.org

Organizations & group practices 8

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 8

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": "1471219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767052800000",
    "number": "1679028013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 ST LUKES BLVD",
            "city": "EASTON",
            "state": "PA",
            "postal_code": "180455671",
            "telephone_number": "908-847-2830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 ST LUKES BLVD",
            "city": "EASTON",
            "state": "PA",
            "postal_code": "180455671",
            "telephone_number": "908-847-2830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAVULICH",
        "first_name": "ANNIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-15",
        "last_updated": "2025-12-30",
        "certification_date": "2025-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA058359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Easton, PA

Sources for this page

Verify at the official NPI Registry.