Kathryn Supko, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

400 Warren Ave Ste 200
Bremerton, WA 98337-1467

Phone

(360) 377-3776

NPI assigned

Feb 7, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kathryn.supko.1@13902.direct.athenahealth.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.

• Peninsula Community Health Services

  • Federally Qualified Health Center (FQHC)
  • Bremerton, WA
  • NPI 1982654182
  Medicare reassignment
• Peninsula Community Health Services

  • Federally Qualified Health Center (FQHC)
  • Poulsbo, WA
  • NPI 1831912021
  NPD
• Peninsula Community Health Services

  • Federally Qualified Health Center (FQHC)
  • Port Orchard, WA
  • NPI 1205886934
  NPD (past)
• Peninsula Community Health Services

  • Federally Qualified Health Center (FQHC)
  • Bremerton, WA
  • NPI 1679216501
  NPD (past)
• Peninsula Community Health Services

  • Federally Qualified Health Center (FQHC)
  • Bremerton, WA
  • NPI 1730822602
  NPD (past)

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

{
    "created_epoch": "1675728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1710683099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 WARREN AVE STE 200",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983371467",
            "telephone_number": "360-377-3776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 WARREN AVE STE 200",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983371467",
            "telephone_number": "360-377-3776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPKO",
        "first_name": "KATHRYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-07",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina M. Sullivan, PT
• George Blake Sullivan
• Thomas Patrick Sullivan, PTA
• Sheba Summers
• Sunbrooke Senior Living LLC Dba Cypress Gardens Retirement
• Robin Supplee
• Erin Elizabeth Sutcliffe, ATC
• Ronald Sutherland
• Michael Swann, MS, LMHC, NCC, CRC
• Jeanette Swanson

• Medical Physician Assistant in Bremerton, WA
• Providers in Bremerton, WA by specialty
• Medical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; 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.