Kirk G Andrus, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G34543 Issued in CA

Practice address

4135 Main St
Kelseyville, CA 95451-8941

Phone

(707) 279-1888

Fax

(707) 279-2832

NPI assigned

Jul 27, 2006

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kandrus17804@hisp.ehr.sutterhealth.org

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Hospice Service of Lake County

  • Community Based Hospice Care Agency
  • Lakeport, CA
  • NPI 1801893177

  Contracted Managing Employee, Corporate Director

  CMS ownership

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.

• Hospice Service of Lake County

  • Community Based Hospice Care Agency
  • Lakeport, CA
  • NPI 1801893177

  Family Medicine

  Medicare reassignment NPD
• Kirk G Andrus MD

  • Family Medicine Physician
  • Kelseyville, CA
  • NPI 1700066529
  Authorized official Same address or phone
• North Coast Faculty Medical Group Inc

  dba Sutter Medical Group of the Redwoods

  • Otolaryngology Physician
  • Sebastopol, CA
  • NPI 1750616512
  NPD (past)

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1699789891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4135 MAIN ST",
            "city": "KELSEYVILLE",
            "state": "CA",
            "postal_code": "954518941",
            "telephone_number": "707-279-1888",
            "fax_number": "707-279-2832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4135 MAIN ST",
            "city": "KELSEYVILLE",
            "state": "CA",
            "postal_code": "954518941",
            "telephone_number": "707-279-1888",
            "fax_number": "707-279-2832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDRUS",
        "first_name": "KIRK",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G34543",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G34543",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G345430",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA LICENSE",
            "identifier": "G34543",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adventist Health Clearlake Hospital Inc. (Adventist Health Clear Lake)
• Advocates for Independent Living
• Leila Arlene Alvarez
• Blue Chair of California
• Bradley Smith Innovative Physical Therapy
• Cali Medical Transport LLC
• Gloria Campbell, MA
• Ruby C Carlson Larson, DDS

• Family Medicine Physician in Kelseyville, CA
• Providers in Kelseyville, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.