Individual provider Active NPI

Mark Jeremy Kulbieda, M.D.

  • Anesthesiology Physician
  • Petoskey, MI
National Provider Identifier
1922038058
Registry record updated Sep 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
4301079164 Issued in MI
Practice address
416 Connable Ave
Petoskey, MI 49770-2212
Phone
(231) 348-2795
Fax
(231) 348-2031
NPI assigned
Jul 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2012

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 4301079164 MI Primary

Addresses

Primary practice location

416 Connable Ave
Petoskey, MI 49770-2212

Mailing address

602 Jackson St
Petoskey, MI 49770-2220
Phone (231) 348-2795

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20110217000799 MI Practitioner - Anesthesiology 8527249937 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Michigan Medical School, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northern Anesthesia Providers PCGroup PAC ID 4789579863, 31 clinicians

Practice addresses (Care Compare)

416 Connable Ave
Petoskey, MI 49770-2212
Phone (231) 487-4000

Hospital & facility affiliations

  • McLaren Northern Michigan Hospital, Petoskey, MI, CCN 230105

Merit-based Incentive Payment System (MIPS)

Final score
80.53 of 100Reported as group
Quality
90
Improvement activities
20
Cost
78.43

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301079164MIMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Anesthesia Providers PC Anesthesiology CurrentSince Jun 1, 2002 Accepting new patients

Locations

602 Jackson St
Petoskey, MI 49770
Phone (231) 348-2795

416 Connable Ave
Petoskey, MI 49770
Phone (231) 487-4000

Organizations & group practices 1

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": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348185600000",
    "number": "1922038058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 JACKSON ST",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702220",
            "telephone_number": "231-348-2795",
            "fax_number": "231-348-2031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 CONNABLE AVE",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702212",
            "telephone_number": "231-348-2795",
            "fax_number": "231-348-2031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KULBIEDA",
        "first_name": "MARK",
        "middle_name": "JEREMY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2012-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "4301079164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petoskey, MI

Sources for this page

Verify at the official NPI Registry.