Active NPI
Johann Kuppers, M.D.
- Student in an Organized Health Care Education/Training Program
- Olympia, WA
National Provider Identifier
1881266716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 525 Lilly Rd NE
Olympia, WA 98506 - Phone
- (360) 493-7525
- NPI assigned
- Jul 12, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | ML61164276 | WA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
525 Lilly Rd NE
Olympia, WA 98506
Mailing address
3800 14TH Ave SE
Apt A7
Lacey, WA 98503
Phone (626) 838-8251
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ML61164276 | WA | MD | Family Medicine Physician |
Interoperability endpoints
- jkuppers1725028@wm.providencedirect.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645488000000",
"number": "1881266716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3800 14TH AVE SE",
"address_2": "APT A7",
"city": "LACEY",
"state": "WA",
"postal_code": "98503",
"telephone_number": "626-838-8251"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 LILLY RD NE",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "98506",
"telephone_number": "360-493-7525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUPPERS",
"first_name": "JOHANN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-07-12",
"last_updated": "2022-02-22",
"certification_date": "2022-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "ML61164276",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olympia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.