NPIMap

Individual provider Active NPI

Charles J Kucera, MD

  • Family Medicine Physician
  • Sumner, WA
National Provider Identifier
1811004351
Registry record updated Mar 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD60057955 Issued in WA
Practice address
5814 Graham Ave Ste 100
Sumner, WA 98390-2728
Phone
(253) 891-7450
NPI assigned
Aug 23, 2006
Last updated
Mar 27, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 41843 WI
Family Medicine Physician 207Q00000X 36085832 IL
Family Medicine Physician 207Q00000X MD60057955 WA Primary

Addresses

Primary practice location

5814 Graham Ave Ste 100
Sumner, WA 98390-2728

Mailing address

5814 Graham Ave Ste 100
Sumner, WA 98390-2728
Phone (253) 891-7450

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
I20090618000670 WA Practitioner - Family Practice 4688615800 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: General Surgery
Education
Rush Medical College of Rush University, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Select Outpatient Services IncGroup PAC ID 4082868815, 750 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

2600 Compass Rd
Glenview, IL 60026-8001

311 S L St
Tacoma, WA 98405-3720

4700 Point Fosdick Dr
Gig Harbor, WA 98335-1706

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36085832ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of Washington CurrentSince May 6, 2009 Accepting new patients
Multicare Health System CurrentSince Jun 1, 2013 Accepting new patients
Kaiser Foundation Health Plan of Washington Current Accepting new patients
Multicare Health System Current Accepting new patients
Multicare Health System CurrentSince Jun 1, 2013 Accepting new patients
Multicare Health System Family Medicine Past Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

4215 49th Ave NE
Tacoma, WA 98422
Phone (253) 459-7699

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

Interoperability endpoints

  • Direct secure messaging: ckucera117399@direct.multicare.org

Organizations & group practices 10

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": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395878400000",
    "number": "1811004351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5814 GRAHAM AVE STE 100",
            "city": "SUMNER",
            "state": "WA",
            "postal_code": "983902728",
            "telephone_number": "253-891-7450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5814 GRAHAM AVE STE 100",
            "city": "SUMNER",
            "state": "WA",
            "postal_code": "983902728",
            "telephone_number": "253-891-7450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUCERA",
        "first_name": "CHARLES",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-23",
        "last_updated": "2014-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "41843",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "36085832",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60057955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sumner, WA

Sources for this page

Verify at the official NPI Registry.