Individual provider Active NPI

Derek Edward Kunz, M.D.

  • Sports Medicine (Emergency Medicine) Physician
  • Washington, DC
National Provider Identifier
1760740708
Registry record updated Aug 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Emergency Medicine) PhysicianTaxonomy code 207PS0010X
License
0101257966 Issued in VA
Practice address
110 Irving St NW
Dept of Emergency Medicine
Washington, DC 20010-3017
Phone
(202) 877-8080
Fax
(202) 877-7633
NPI assigned
Apr 27, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 28, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X M13319 ID
Student in an Organized Health Care Education/Training Program 390200000X
Sports Medicine (Emergency Medicine) Physician 207PS0010X 0101257966 VA Primary

Addresses

Primary practice location

110 Irving St NW
Dept of Emergency Medicine
Washington, DC 20010-3017

Mailing address

110 Irving St NW
Dept of Emergency Medicine
Washington, DC 20010-3017
Phone (202) 877-8080

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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

Enrollment IDStateProvider typePAC IDDetails
I20160725002188 ID Practitioner - Sports MedicinePractitioner - Emergency Medicine 0446575591 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Sports Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint Alphonsus Regional Medical Center IncGroup PAC ID 3476462359, 672 clinicians

Practice addresses (Care Compare)

3025 W Cherry LN
Meridian, ID 83642-8531

6022 W Emerald St
Boise, ID 83704-8855
Phone (208) 367-4603

6094 W Emerald St
Boise, ID 83704-8855
Phone (208) 302-1000

6165 W Emerald St
Boise, ID 83704-8613
Phone (208) 302-3500

Hospital & facility affiliations

  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007
  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • Saint Alphonsus Medical Center - Nampa Hospital, Nampa, ID, CCN 130013

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M13319IDMDEmergency Medicine Physician
0101257966VAMDSports Medicine (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America LLC Emergency Medicine CurrentSince Oct 1, 2017 Accepting new patients
Cep America, LLC Emergency Medicine Current Accepting new patients
Cep America, LLC Emergency Medicine CurrentSince Oct 1, 2017 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Current Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Sep 1, 2018 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Sep 1, 2018 Accepting new patients

Locations

2100 Powell St
Ste 900
Emeryville, CA 94608
Phone (510) 350-2777

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

6165 W Emerald St
Boise, ID 83704
Phone (208) 302-3500

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

6140 W Curtisian Ave
Ste 200
Boise, ID 83704
Phone (208) 363-9074

6140 W Curtisian Ave
Ste 2
Boise, ID 83704

6051 W Emerald St
Boise, ID 83704
Phone (208) 302-5100

3025 W Cherry Ln
Meridian, ID 83642
Phone (208) 302-6400

3340 E Goldstone Dr
Meridian, ID 83642
Phone (208) 302-9342

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

Interoperability endpoints

  • Direct secure messaging: dkunz1563982@direct.trinity-health.org

Organizations & group practices 6

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.

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": "1335484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503878400000",
    "number": "1760740708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 IRVING ST NW",
            "address_2": "DEPT OF EMERGENCY MEDICINE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200103017",
            "telephone_number": "202-877-8080",
            "fax_number": "202-877-7633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 IRVING ST NW",
            "address_2": "DEPT OF EMERGENCY MEDICINE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200103017",
            "telephone_number": "202-877-8080",
            "fax_number": "202-877-7633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUNZ",
        "first_name": "DEREK",
        "middle_name": "EDWARD",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-27",
        "last_updated": "2017-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ID",
            "license": "M13319",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207PS0010X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "VA",
            "license": "0101257966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.