NPIMap

Organization Active NPI

MBK Gastro LLC

  • Gastroenterology Physician
  • Lawrenceville, GA
National Provider Identifier
1912598699
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
MBK GASTRO LLC
Practice address
763 Old Norcross Rd
Lawrenceville, GA 30046-4317
Phone
(770) 883-1176
Fax
(678) 985-1999
NPI assigned
Jan 27, 2021
Organization subpart
Yes
Parent organization
MBK GASTRO LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Authorized official

Name
Mark B Kukler, DONPI 1093765265
Title
Managing Physician
Phone
(770) 883-1176

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

763 Old Norcross Rd
Lawrenceville, GA 30046-4317

Mailing address

763 Old Norcross Rd
Lawrenceville, GA 30046-4317
Phone (770) 883-1176

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Lawrenceville Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210520001262 GA Part B Supplier - Clinic/Group Practice 3678972809 Receives reassigned benefits from 1 practitioner
Practice locations: Lawrenceville, GA

National Provider Directory

National Provider Directory
Part of
MBK Gastro LLC

Locations

2295 Ronald Reagan Pkwy
Ste 100
Snellville, GA 30078

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1611705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616976000000",
    "number": "1912598699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "763 OLD NORCROSS RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464317",
            "telephone_number": "770-883-1176",
            "fax_number": "678-985-1999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "763 OLD NORCROSS RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464317",
            "telephone_number": "770-883-1176",
            "fax_number": "678-985-1999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MBK GASTRO LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MBK GASTRO LLC",
        "enumeration_date": "2021-01-27",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A",
        "authorized_official_last_name": "KUKLER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MANAGING PHYSICIAN",
        "authorized_official_telephone_number": "770-883-1176",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Lawrenceville",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "763 Old Norcross Rd",
            "city": "Lawrenceville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300464317",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.