KAITLIN BUCKNER (P.A.) – Physician Assistant, NPI 1104852094
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,876 PHYSICIAN ASSISTANT in OR
Provider Addresses for KAITLIN BUCKNER (P.A.)
550 MAIN ST STE 190
NEW BRIGHTON, MN 551123271
Phone: (612) 454-2046
Fax: (612) 454-2046
Type: Mailing
10180 SE Sunnyside Rd
Clackamas, OR 970158970
Phone: (800) 813-2000
Type: Location
64 TOUCHSTONE
LAKE OSWEGO, OR 970351909
Phone: (702) 994-4332
Type: Mailing
6043 HUDSON RD STE 220
WOODBURY, MN 551251033
Phone: (651) 925-8200
Fax: (651) 925-8201
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-11-06
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 5 Medicare enrollment records; no due dates published yet.
Enrollment records
5
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20081229000573 | I | Physician Assistant | MN | TBD |
| I20150306000973 | I | Physician Assistant | TX | TBD |
| I20220105002934 | I | Physician Assistant | AK | TBD |
| I20250529004236 | I | Physician Assistant | OR | TBD |
| I20251106002211 | I | Physician Assistant | WA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 55112)
Loading plans...
Group practice members
| Name | Specialty | State |
|---|---|---|
| Diagnostic Radiology | NC | |
| - | WA | |
| - | UT | |
| Emergency Medicine | AZ | |
| Diagnostic Radiology | AK | |
| O P T O M E T R Y | OR | |
| Family Practice | AK | |
| - | AK | |
| Nurse Practitioner | ND | |
| Physician Assistant | CO |
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.