Kevin J Kolcun, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA00982 Issued in OR

Practice address

2200 NE Neff Rd
Bend, OR 97701-4283

Phone

(541) 382-3344

Fax

(541) 382-1681

NPI assigned

Jun 28, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kkolcun19279@thecenter.gardenplotortho.direct-ci.com

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.

• Bend Memorial Clinic PC

  • Family Medicine Physician
  • Bend, OR
  • NPI 1699827477

  Physician Assistant

  Medicare reassignment NPD
• Bend Memorial Clinic PC

  • Clinical Medical Laboratory
  • Bend, OR
  • NPI 1972144913
  NPD

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

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652054400000",
    "number": "1679579247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 NE NEFF RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977014283",
            "telephone_number": "541-382-3344",
            "fax_number": "541-382-1681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 NE NEFF RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977014283",
            "telephone_number": "541-382-3344",
            "fax_number": "541-382-1681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLCUN",
        "first_name": "KEVIN",
        "middle_name": "J",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-28",
        "last_updated": "2022-05-09",
        "certification_date": "2022-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA00982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kevinkolcun@tc.allscriptsdirect.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2200 NE Neff Rd",
            "city": "Bend",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977014283",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Thomas Frederick Koehler, MD
• Patricia Marie Koenig, L.P.N.
• Jason Larry Koerner, MD
• Erica Kokkeler, CFNC
• Susan Kolb, MS, LPC
• Richard Lynn Koller, M.D.
• Dylan Konkle, D.C.
• David Koonce, LMT
• Tonya I Koopman, NP
• Taylor Kopecky, DPT

• Physician Assistant in Bend, OR
• Providers in Bend, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.