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MR. KORDALE TRE BAVOR NP
NPI 1659984631
Nurse Practitioner - Pediatrics in Bonney Lake, WA

Active since August 28, 2020PECOS Enrolled
10004 204TH AVE E STE 1300, BONNEY LAKE, WA 98391(253) 848-8797 Get Directions Write a Review

NPPES record last updated: August 22, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Aug 22, 2023, Aug 28, 2020 (2 updates tracked since 2020).

About Mr. Kordale Tre Bavor Np NPPES

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

MR. KORDALE TRE BAVOR NP (NPI 1659984631) is an individual pediatrics provider in Bonney Lake, Washington, licensed in Washington (61422757) and active in the NPI registry since August 2020. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1659984631
Entity TypeIndividualMale
Primary Taxonomy363LP0200X
Provider Legal NameMR. KORDALE TRE BAVORCredential: NP
Location Address10004 204TH AVE E STE 1300Bonney Lake, WA 98391-6537
Mailing Address10004 204th Ave E Ste 1300Bonney Lake, WA 98391-6537 · (253) 848-8797
Phone(253) 848-8797
Sole ProprietorNo
Enumeration DateAugust 28, 2020
Last NPPES UpdateAugust 22, 20232 updates tracked since enumeration
NPPES CertifiedAugust 22, 2023
✔ NPI 1659984631 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · PediatricsPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0200X
License✔ Licensed in WA · 61422757
10004 204TH AVE E STE 1300, Bonney Lake, WA 98391
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Premera Blue Cross Blue Shield of Alaska, Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Kordale Tre Bavor Np 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 Kordale Bavor reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Multicare Health System
6.5 mi
Community/Behavioral Health
325 E. PIONEER
Puyallup, WA 98372
  • Reassigned Medicare billing, Washington enrollment
  • 4,383 clinicians in this Medicare group
NPI 1700925351 (253) 697-8548

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 98391 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
$88.29 typical visit price
range $57.27 – $172.80
Typical copayment $22.07 (range $14.31 – $43.20)
Most-billed visit code 99203
Established Patient
$100.78 typical visit price
range $18.56 – $141.11
Typical copayment $25.19 (range $4.64 – $35.27)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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 Kordale Bavor's NPI number?

The NPI number for Kordale Bavor is 1659984631. It was assigned to this individual provider in the NPPES registry on August 28, 2020.

Where is Kordale Bavor located?

Kordale Bavor practices at 10004 204th Ave E Ste 1300, Bonney Lake, WA 98391. The listed phone number is (253) 848-8797.

What is Kordale Bavor's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.

Is Kordale Bavor enrolled in Medicare?

Yes. Kordale Bavor is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kordale Bavor's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kordale Bavor reassigns Medicare benefits to Multicare Health System (Puyallup, WA). 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 Kordale Bavor's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kordale Bavor accept?

Health plans from Ambetter Health, Premera Blue Cross Blue Shield of Alaska and Providence Health Plan list Kordale Bavor as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kordale Bavor was last updated on August 22, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.