Individual provider Active NPI

Brent L Kutach, D.O.

  • Anesthesiology Physician
  • Waco, TX
National Provider Identifier
1821187402
Registry record updated Sep 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
K6070 Issued in TX
Practice address
405 Londonderry Dr
Suite 105
Waco, TX 76712-7924
Phone
(254) 776-0266
Fax
(254) 776-2511
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X K6070 TX Primary

Addresses

Primary practice location

405 Londonderry Dr
Suite 105
Waco, TX 76712-7924

Mailing address

PO Box 224137
Dallas, TX 75222-4137
Phone (254) 776-0266

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20080604000484 TX Practitioner - Anesthesiology 4880764877 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1401 E 8TH St
Weslaco, TX 78596-6640
Phone (956) 968-8567

609 Medical Ctr Dr
Decatur, TX 76234-3836
Phone (940) 627-5921

Hospital & facility affiliations

  • Medical City Denton Hospital, Denton, TX, CCN 450634
  • Medical City Alliance Hospital, Fort Worth, TX, CCN 670103

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
K6070TXMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Anesthesia of Huntsville a Division of Premier Anesthesia LLC Anesthesiology CurrentSince Apr 1, 2017 Accepting new patients
Northstar Anesthesia, PA Anesthesiology CurrentSince Sep 9, 2016 Accepting new patients
Waco Pathology Associates, P.a. Past Accepting new patients

Locations

100 E Alton Gloor Blvd
Brownsville, TX 78526
Phone (956) 350-7000

909 9th Ave
Ft Worth, TX 76104
Phone (817) 336-6060

5501 S Expressway 77
Harlingen, TX 78550
Phone (936) 569-9481

1917 Ashland St
Houston, TX 77008
Phone (713) 861-6161

6200 W Parker Rd
Plano, TX 75093
Phone (972) 608-8000

1401 E 8th St
Weslaco, TX 78596
Phone (956) 581-0303

Organizations & group practices 3

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 2

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": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222300800000",
    "number": "1821187402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 224137",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752224137",
            "telephone_number": "254-776-0266",
            "fax_number": "254-776-2511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 LONDONDERRY DR",
            "address_2": "SUITE 105",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767127924",
            "telephone_number": "254-776-0266",
            "fax_number": "254-776-2511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUTACH",
        "first_name": "BRENT",
        "middle_name": "L",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2008-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TX",
            "license": "K6070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.