NPIMap

Individual provider Active NPI

Cheryl L Kukich, PA

  • Medical Physician Assistant
  • Mayfield HTS, OH
National Provider Identifier
1689975138
Registry record updated Apr 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
50.004044RX Issued in OH
Practice address
300 Allen Bradley Dr
Mayfield HTS, OH 44124-6131
Phone
(440) 459-5000
Fax
(877) 712-6578
NPI assigned
Nov 15, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 5601005909 MI
Medical Physician Assistant 363AM0700X 085003953 IL
Medical Physician Assistant 363AM0700X 50.004044RX OH Primary

Addresses

Primary practice location

300 Allen Bradley Dr
Mayfield HTS, OH 44124-6131

Mailing address

300 Allen Bradley Dr
Mayfield HTS, OH 44124-6131
Phone (440) 459-5000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140924002317 OH Practitioner - Physician Assistant 9739377052 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cleveland ClinicGroup PAC ID 1850203555, 6,954 clinicians

Practice addresses (Care Compare)

16761 Southpark Ctr
Strongsville, OH 44136-9302
Phone (440) 878-2500

17840 Bagley Rd
Middleburg Heights, OH 44130-3401
Phone (440) 531-6000

3574 Ctr Rd
Brunswick, OH 44212-3618
Phone (330) 225-8886

8950 Euclid Ave
Cleveland, OH 44195-0001
Phone (216) 444-8950

9500 Euclid Ave
Cleveland, OH 44195-0001

Hospital & facility affiliations

  • Cleveland Clinic Hospital, Cleveland, OH, CCN 360180

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085003953ILMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Cleveland Clinic Foundation CurrentSince Aug 19, 2014 Accepting new patients
The Cleveland Clinic Foundation CurrentSince Aug 19, 2014 Accepting new patients
Laser Spine Institute, LLC Past Accepting new patients

Locations

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

Organizations & group practices 16

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.

View all 16

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": "1289779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461024000000",
    "number": "1689975138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 ALLEN BRADLEY DR",
            "city": "MAYFIELD HTS",
            "state": "OH",
            "postal_code": "441246131",
            "telephone_number": "440-459-5000",
            "fax_number": "877-712-6578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 ALLEN BRADLEY DR",
            "city": "MAYFIELD HTS",
            "state": "OH",
            "postal_code": "441246131",
            "telephone_number": "440-459-5000",
            "fax_number": "877-712-6578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUKICH",
        "first_name": "CHERYL",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-15",
        "last_updated": "2016-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601005909",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085003953",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OH",
            "license": "50.004044RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mayfield HTS, OH

Sources for this page

Verify at the official NPI Registry.