NPIMap

Individual provider Active NPI

Kristopher S. Dunbrack, M.D.

  • Family Medicine Physician
  • Enumclaw, WA
National Provider Identifier
1699126755
Registry record updated Oct 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD60900974 Issued in WA
Practice address
3021 Griffin Ave
Enumclaw, WA 98022
Phone
(360) 825-6511
Fax
(360) 825-6536
NPI assigned
Jun 29, 2016
Last updated
Oct 10, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD60900974 WA Primary

Addresses

Primary practice location

3021 Griffin Ave
Enumclaw, WA 98022

Mailing address

3021 Griffin Ave
Enumclaw, WA 98022-2369
Phone (360) 825-6511

Other practice location 1

2400 W Villard Ave
Milwaukee, WI 53209-4901
Phone (414) 527-5619

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20191113003143 WA Practitioner - Family Practice 4183974546 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians

Practice addresses (Care Compare)

3021 Griffin Ave
Enumclaw, WA 98022-2369
Phone (360) 825-6511

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD60900974WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Medical Group Current Accepting new patients
Franciscan Medical Group Family Medicine CurrentSince Sep 15, 2019 Accepting new patients
Franciscan Medical Group Family Medicine Past Accepting new patients

Locations

3021 Griffin Ave
Enumclaw, WA 98022
Phone (253) 833-6241

34503 9th Ave S
Ste 130
Federal Way, WA 98003
Phone (253) 835-5340

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

Interoperability endpoints

  • Direct secure messaging: kdunbrack528248@fhsce.catholichealth.net

Organizations & group practices 3

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": "1467158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570665600000",
    "number": "1699126755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3021 GRIFFIN AVE",
            "city": "ENUMCLAW",
            "state": "WA",
            "postal_code": "980222369",
            "telephone_number": "360-825-6511",
            "fax_number": "360-825-6536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3021 GRIFFIN AVE",
            "city": "ENUMCLAW",
            "state": "WA",
            "postal_code": "98022",
            "telephone_number": "360-825-6511",
            "fax_number": "360-825-6536"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2400 W Villard Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532094901",
            "country_code": "US",
            "telephone_number": "414-527-5619",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUNBRACK",
        "first_name": "KRISTOPHER",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-29",
        "last_updated": "2019-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60900974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Enumclaw, WA

Sources for this page

Verify at the official NPI Registry.