NPIMap

Individual provider Active NPI

Kevin Louis Kruenegel, PA-C

  • Physician Assistant
  • Medford, OR
National Provider Identifier
1992022693
Registry record updated Feb 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
196530 Issued in OR
Practice address
555 Black Oak Dr
Medford, OR 97504-8447
Phone
(541) 789-8176
Fax
(541) 789-4806
NPI assigned
Apr 21, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 005820 GA
Physician Assistant 363A00000X 196530 OR Primary

Addresses

Primary practice location

555 Black Oak Dr
Medford, OR 97504-8447

Mailing address

2825 E Barnett Rd
Medford, OR 97504-8332
Phone (541) 789-8176

Other practice location 1

11700 Mercy Blvd
Bldg. 5
Savannah, GA 31419-1753
Phone (912) 927-6270

Other identifiers 1

IdentifierTypeStateIssuer
003129392AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191224000328 OR Practitioner - Physician Assistant 6204951163 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Asante Physician PartnersGroup PAC ID 8325206246, 227 clinicians

Practice addresses (Care Compare)

280 Maple St
Ashland, OR 97520-1552
Phone (541) 201-4000

2825 E Barnett Rd
Medford, OR 97504-8332
Phone (541) 789-7000

500 SW Ramsey Ave
Grants Pass, OR 97527-5554
Phone (541) 472-7000

555 Black Oak Dr
Medford, OR 97504-8491

625 SW Ramsey Ave
Suite a
Grants Pass, OR 97527-5808
Phone (541) 507-2290

Hospital & facility affiliations

  • Asante Rogue Regional Medical Center Hospital, Medford, OR, CCN 380018
  • Asante Three Rivers Medical Center Hospital, Grants Pass, OR, CCN 380002
  • Asante Ashland Community Hospital Hospital, Ashland, OR, CCN 380005
  • Curry General Hospital Hospital, Gold Beach, OR, CCN 381322
  • Fairchild Medical Center Hospital, Yreka, CA, CCN 051316

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
005820GAMDPhysician Assistant
196530ORMDPhysician Assistant

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 7

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": "1271808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581552000000",
    "number": "1992022693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2825 E BARNETT RD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048332",
            "telephone_number": "541-789-8176",
            "fax_number": "541-789-4806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 BLACK OAK DR",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048447",
            "telephone_number": "541-789-8176",
            "fax_number": "541-789-4806"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11700 Mercy Blvd",
            "address_2": "Bldg. 5",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314191753",
            "country_code": "US",
            "telephone_number": "912-927-6270",
            "fax_number": "912-927-6254",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRUENEGEL",
        "first_name": "KEVIN",
        "middle_name": "LOUIS",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-21",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "005820",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "196530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003129392A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.