NPIMap

Individual provider Active NPI

Kurt A Ick, MD

  • Urology Physician
  • Kingsport, TN
National Provider Identifier
1760439152
Registry record updated Mar 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
MD28950 Issued in TN
Practice address
1932 Brookside Dr
Kingsport, TN 37660
Phone
(423) 246-4155
Fax
(423) 246-7169
NPI assigned
May 30, 2006
Last updated
Mar 15, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X MD28950 TN Primary

Addresses

Primary practice location

1932 Brookside Dr
Kingsport, TN 37660

Mailing address

1932 Brookside Dr
Kingsport, TN 37660
Phone (423) 246-4155

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Kansas School of Med (KC/Wich/Sal), 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

PO Box
Suite 80690
Canton, OH 44708

PO Box
Suite 80690
Cannon, OH 44708-0690

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD28950TNMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellmont Health System Current Accepting new patients
Invigilo Anesthesia Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kick26259@balladhealth.medalliesdirect.net

Organizations & group practices 2

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 4

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": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300147200000",
    "number": "1760439152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1932 BROOKSIDE DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "37660",
            "telephone_number": "423-246-4155",
            "fax_number": "423-246-7169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1932 BROOKSIDE DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "37660",
            "telephone_number": "423-246-4155",
            "fax_number": "423-246-7169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ICK",
        "first_name": "KURT",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-30",
        "last_updated": "2011-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "TN",
            "license": "MD28950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

Verify at the official NPI Registry.