Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kevin J. Kruckenberg, PA-C

Individual provider Physician Assistant · NPI 1578237715

Kevin J. Kruckenberg, PA-C is a Physician Assistant in Hartford, Connecticut. Qualified in 2021, 5 years ago. Practices with Umass Memorial Medical Group Inc, a 2,467-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Connecticut and Massachusetts.

Years since qualifying
5
Licensed in
CT, MA
In the registry since
2021
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

80 Seymour St
Hartford, CT 06102-8000
Phone: (860) 716-5348
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 119 Belmont St, Worcester, MA 01605-2903 — (774) 443-7552
  • 55 Lake Ave N, Worcester, MA 01655-0002 — (774) 443-7552

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 007007 (CT)
Physician Assistant Taxonomy 363A00000X · Licence PA8259 (MA)

Record details

NPI number1578237715
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedAugust 2, 2021
Last updated in NPPESMay 27, 2025
Certification dateMay 27, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Umass Memorial Medical Group Inc — 2467 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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