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KENNETH MURRAY EDSTROM MD
NPI 1649373663
Obstetrics & Gynecology in Puyallup, WA

Active since September 06, 2006PECOS Enrolled
1701 3RD ST SE, SUITE 200, PUYALLUP, WA 98372(253) 840-4444(253) 840-5239 Get Directions Write a Review

NPPES record last updated: June 15, 2012. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Kenneth Murray Edstrom Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENNETH MURRAY EDSTROM MD (NPI 1649373663) is an individual obstetrics & gynecology provider in Puyallup, Washington, licensed in Washington (MD00026074) and active in the NPI registry since September 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1649373663
Entity TypeIndividualMale
Primary Taxonomy207V00000X
Provider Legal NameKENNETH MURRAY EDSTROMCredential: MD
Location Address1701 3RD ST SE, SUITE 200Puyallup, WA 98372-4511
Mailing Address1701 3rd St Se, Suite 200Puyallup, WA 98372-4511 · (253) 840-4444 · Fax (253) 840-5239
Phone(253) 840-4444
Fax(253) 840-5239
Sole ProprietorNo
Enumeration DateSeptember 6, 2006
Last NPPES UpdateJune 15, 2012
✔ NPI 1649373663 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians
Taxonomy Code207V00000X
License✔ Licensed in WA · MD00026074
Definition
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
1701 3RD ST SE, Puyallup, WA 98372
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Other Identifiers 3

Medicaid7085020WA
Medicare UPINC92565
Medicare ID-Type UnspecifiedGAB25749

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kenneth Murray Edstrom Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Kenneth Edstrom reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

General Conference Corp Of Sda
Clinic/Center
388 YPAO RD
Tamuning, GU 96913
  • Reassigned Medicare billing, Guam enrollment
  • 105 clinicians in this Medicare group
NPI 1275586877 (671) 646-8881

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 98372 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$130.99 typical visit price
range $57.27 – $172.80
Typical copayment $32.74 (range $14.31 – $43.20)
Most-billed visit code 99204
Established Patient
$71.29 typical visit price
range $18.56 – $141.11
Typical copayment $17.82 (range $4.64 – $35.27)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CHARLES D JACOBSON MD
Internal Medicine
1701 3RD ST SE
PUYALLUP, WA 98372
Pierce County (253) 967-5767
STEPHEN R KERR M.D.
Surgery
1701 3RD ST SE, SUITE 300
PUYALLUP, WA 98372
Pierce County (253) 697-5767
LAURIE J MORRIS MD
Obstetrics & Gynecology
1701 3RD ST SE, SUITE 200
PUYALLUP, WA 98372
Pierce County (253) 840-4444
MOHAMMED HOSAM ALDIN BACCORA MD
Internal Medicine (Nephrology)
1701 3RD ST SE, STE 300
PUYALLUP, WA 98372
Pierce County (253) 697-4740
JESSICA SANTIAGO KHAN MD
Internal Medicine
1701 3RD ST SE
PUYALLUP, WA 98372
Pierce County (253) 697-5767
NICHOL T IVERSON MD
Internal Medicine
1701 3RD ST SE, SUITE 300
PUYALLUP, WA 98372
Pierce County (253) 697-5767
CHARLES NAM MD
Internal Medicine
1701 3RD ST SE, 300
PUYALLUP, WA 98372
Pierce County (253) 697-5767
JEBIN MATHEW CHACKO MD
Psychiatry & Neurology (Neurology)
1701 3RD ST SE
PUYALLUP, WA 98372
Pierce County (253) 697-4747

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenneth Edstrom's NPI number?

The NPI number for Kenneth Edstrom is 1649373663. It was assigned to this individual provider in the NPPES registry on September 6, 2006.

Where is Kenneth Edstrom located?

Kenneth Edstrom practices at 1701 3rd St SE Suite 200, Puyallup, WA 98372. The listed phone number is (253) 840-4444.

What is Kenneth Edstrom's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Is Kenneth Edstrom enrolled in Medicare?

Yes. Kenneth Edstrom is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kenneth Edstrom's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kenneth Edstrom reassigns Medicare benefits to General Conference Corp Of Sda (Tamuning, GU). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kenneth Edstrom's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Kenneth Edstrom was last updated on June 15, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.