DR. LEO KUSUDA (NPI# 1578533303) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578533303 |
| Entity Type | Individual |
| Full Name | DR. LEO KUSUDA |
| Credential | M.D. |
| Practice Address |
1900 Woodland Dr Coos Bay OR 97420-0000 |
| Practice Telephone | 5412675151 |
| Practice Fax Number | 5412664574 |
| Mailing Telephone | 5412675151 |
| Mailing Fax Number | 5412664574 |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2012-02-27 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | MD27316 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | MEDICARE GROUP NPI NUMBER | 1407812365 | 01 |
| OR | RR PTAN MEDICARE NUMBER | P00406434 | 01 |
| OR | NBMC GROUP MEDICAID | 161133 | 01 |
| OR | RR MEDICARE GROUP NUMBER | CB3544 | 01 |
| OR | MEDICARE GROUP PIN NUMBER | R0000WFBTV | 01 |
| OR | 218174 | 05 | |
| OR | DMERC | 0577260001 | 01 |
| Street Address |
1900 WOODLAND DR |
| City | COOS BAY |
| State | OR |
| Zip Code | 97420-0000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174517528 | Mary Irene Hernandez | Physical Therapist | 1900 Woodland Dr, Coos Bay, OR 97420 | 2005-08-31 |
| 1477189009 | Sandy Lynn Teeter | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2020-03-16 |
| 1114564630 | Mitaliben Rajendrakumar Gor | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2019-12-03 |
| 1568014942 | Nikkona Henderson | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2045 | 2019-07-15 |
| 1861050189 | James Murray | Dermatology | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2019-06-01 |
| 1346803640 | Sophia Elizabeth Massey | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2019-04-22 |
| 1750857090 | Alaina Therese Hendrix | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2018-10-14 |
| 1801382155 | Yulia Viktorovna Whidden | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2018-07-10 |
| 1124525043 | Samantha Decker | Dermatology | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2018-04-07 |
| 1043712383 | Gregory Sopka | Physician Assistant | 1900 Woodland Dr, Coos Bay, OR 97420-2045 | 2018-03-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346880606 | Danielle Goette | Massage Therapist | 320 Central Ave Suite 226, Coos Bay, OR 97420 | 2020-01-14 |
| 1730643735 | Nicole Hand-therapeutic Massage | Massage Therapist | 3229 Broadway Avenue, Suite D, Coos Bay, OR 97420 | 2019-01-24 |
| 1528531100 | A Better Reality | Clinic/Center | 2690 N. 17th Sstreet, Coos Bay, OR 97420 | 2019-01-07 |
| 1396216883 | Elizabeth Rose Stephens | Health Educator | 97381 Newport Lane, Coos Bay, OR 97420 | 2018-12-10 |
| 1093263386 | Megan Smith | Physician Assistant | 375 Park Ave Ste 5, Coos Bay, OR 97420 | 2016-09-14 |
| 1285091884 | Richard T Rigney | Counselor | 62754 Karl Road, Coos Bay, OR 97420 | 2016-01-27 |
| 1821493032 | James Thomas Agee | Pharmacist | 2051 Newmark Avenue, Walmart Pharmacy 1880, Coos Bay, OR 97420 | 2014-10-30 |
| 1346663895 | Steven D. Richardson D.m.d. L.l.c | Dentist | 1835 Ocean Blvd Se, Coos Bay, OR 97420 | 2014-02-03 |
| 1144669243 | Michael Jason Cole | Pharmacist | 1020 South First Ave, Coos Bay, OR 97420 | 2013-06-21 |
| 1639518053 | Jonathan Thomas Small | Physical Therapist | 2645 North 17th St, Coos Bay, OR 97420 | 2013-06-19 |
| Find all providers in zip 97420 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609233824 | Jeremiah C. Murphy, M.d., PC | Urology | 19260 Sw 65th Ave Ste 400, Tualatin, OR 97062-5712 | 2016-01-19 |
| 1609200427 | Erika Lynn Mccarthy | Urology | 2973 12th St Se, Salem, OR 97302-3162 | 2013-08-28 |
| 1770826372 | Brian Matthew Blair | Urology | 24900 Se Stark St Ste 103, Gresham, OR 97030 | 2013-04-02 |
| 1376885418 | Sasha Courand Druskin | Urology | 2226 Nw Pettygrove St, Portland, OR 97210-2608 | 2013-03-26 |
| 1871837468 | Kirit S Shah M.d., P.C. | Urology | 171 Ne 102nd Ave, Portland, OR 97220-4169 | 2012-11-20 |
| 1235409236 | Good Samaritan Hospital Corvallis | Urology | 990 Nw Circle Blvd Suite 102, Corvallis, OR 97330-1967 | 2012-01-06 |
| 1679856439 | Thomas William Konowalchuk | Urology | 1070 Ne 7th Dr, Newport, OR 97365-2518 | 2011-09-27 |
| 1730484544 | James Bresee | Urology | 9135 Sw Barnes Rd Ste 663, Portland, OR 97225 | 2011-01-26 |
| 1063734556 | Gene Thomas Baumgarner | Urology | 3986 Mirror Pond Way, Eugene, OR 97408-5954 | 2010-02-24 |
| 1144470568 | Daniel R Khalil | Urology | 700 Sw Ramsey Suite 101, Grants Pass, OR 97527-5535 | 2008-09-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.