Charles Kotulski, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ML60863184 Issued in WA

Practice address

9040 Jackson Ave
Tacoma, WA 98431-0001

Phone

(253) 968-3885

NPI assigned

May 31, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WI, WA2 enrollments

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 2

Specialty

Family Practice

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Hospital & facility affiliations

• Puget Sound Home Health Home health agency, Tacoma, WA, CCN 507101
• Othello Community Hospital Hospital, Othello, WA, CCN 501318

Merit-based Incentive Payment System (MIPS)

Final score

80.58 of 100Reported as group

Quality

55.5

Promoting interoperability

100

Improvement activities

40

Cost

71.46

Merit-based Incentive Payment System (MIPS)

Final score

82.72 of 100Reported as group

Quality

64.71

Promoting interoperability

100

Improvement activities

40

Cost

65.56

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: him@marshfieldclinichealthsystem.cernerdirect.com

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.

• Adams County Public Hospital District 3

  • Critical Access Hospital
  • Othello, WA
  • NPI 1811108822
  Medicare reassignment NPD
• Grant County Public Hospital District 3

  • Emergency Medical Services (Emergency Medicine) Physician
  • Ephrata, WA
  • NPI 1134283930
  Medicare reassignment NPD
• Beaver Dam Community Hospitals Inc

  • Clinic/Center
  • Beaver Dam, WI
  • NPI 1972188555
  Medicare reassignment NPD
• Flambeau Hospital Inc

  • Clinic/Center
  • Park Falls, WI
  • NPI 1194317966
  Medicare reassignment NPD
• Flambeau Hospital Inc

  • Critical Access Hospital
  • Park Falls, WI
  • NPI 1700963048
  Medicare reassignment NPD
• Lakeview Medical Center Inc of Rice Lake

  • Clinic/Center
  • Rice Lake, WI
  • NPI 1093201832
  Medicare reassignment NPD
• Marshfield Clinic Inc

  • Clinic/Center
  • Marshfield, WI
  • NPI 1952347981
  Medicare reassignment NPD
• MCHS Hospitals Inc

  • Clinic/Center
  • Marshfield, WI
  • NPI 1093221434

  Emergency Medicine

  Medicare reassignment NPD
• MCHS Hospitals Inc

  • Critical Access Hospital
  • Ladysmith, WI
  • NPI 1952890873
  Medicare reassignment NPD
• Memorial Hospital Inc

  • Critical Access Hospital
  • Neillsville, WI
  • NPI 1346239373
  Medicare reassignment NPD
• Beaver Dam Community Hospitals Inc

  • Pharmacy
  • Beaver Dam, WI
  • NPI 1295771780
  NPD
• MCHS Hospitals Inc

  • Clinic/Center
  • Stevens Point, WI
  • NPI 1467119784
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Adams County Public Hospital District 3

  • Critical Access Hospital
  • Othello, WA
  • NPI 1811108822
  Care Compare affiliation
• Symbol Healthcare, Inc.

  • Home Health Agency
  • Tacoma, WA
  • NPI 1912242678
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727654400000",
    "number": "1902398407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "84042 310TH ST",
            "city": "MADELIA",
            "state": "MN",
            "postal_code": "560625417",
            "telephone_number": "507-380-4069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9040 JACKSON AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984310001",
            "telephone_number": "253-968-3885"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9576 Hwy 70",
            "address_purpose": "LOCATION",
            "city": "Minocqua",
            "state": "WI",
            "postal_code": "545489067",
            "country_code": "US",
            "telephone_number": "715-234-6291",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOTULSKI",
        "first_name": "CHARLES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-31",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "75407-20",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "ML60863184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@marshfieldclinichealthsystem.cernerdirect.com",
            "affiliation": "N",
            "address_1": "9576 Hwy 70",
            "city": "Minocqua",
            "state": "WI",
            "country_code": "US",
            "postal_code": "545489067",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Rochell R. Kostelecky, PA-C
• Teresa Kostrzewski, LPN
• Lily Kostuch, RN
• Timothy Jordan Kotnour
• Brian Richard Kott, MD
• Nikole Koumoutsos
• Monrudee Koutouvidis, ARNP
• Toria L Koutras, DMD
• Carol J Kovanda, MD
• Jennifer L Kovich

• Family Medicine Physician in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.