NPIMap

Individual provider Active NPI

Kelly Kathleen Erickson, PA-C

  • Medical Physician Assistant
  • Juneau, AK
National Provider Identifier
1003914391
Registry record updated Feb 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
666 Issued in AK
Practice address
3245 Hospital Dr
Juneau, AK 99801-7809
Phone
(907) 463-4040
Fax
(907) 463-6663
NPI assigned
Sep 20, 2006
Last updated
Feb 10, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 666 AK Primary

Addresses

Primary practice location

3245 Hospital Dr
Juneau, AK 99801-7809

Mailing address

641 W Willoughby Ave
Ste 201
Juneau, AK 99801-1748
Phone (908) 586-8100

Other identifiers 5

IdentifierTypeStateIssuer
8EB370OtherAKMEDICARE ID -TYPE UNSPECI
8EB371OtherAKMEDICARE ID -TYPE UNSPECI
8EB373OtherAKMEDICARE ID-TYPE UNSPECIF
8ED920OtherAKMEDICARE ID-TYPE UNSPECIF
8EB372OtherAKMEDICARE ID-TYPE UNSPECIF

Other names 1

  • Kelly Kathleen Holzer Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, AK2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050325000542 TX Practitioner - Physician Assistant 6406848159 Reassigns benefits to 1 organization
I20200228000339 AK Practitioner - Physician Assistant 6406848159 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1200 Salmon Creek LN
Juneau, AK 99801-7861
Phone (907) 463-4040

1204 Seward Ave
Searhc 1204 Behavioral Health Sitka
Sitka, AK 99835-7359
Phone (907) 966-8611

1206 Seward Ave
Searhc 1206 Behavioral Health Sitka
Sitka, AK 99835-7359
Phone (907) 966-8611

1209 Seward Ave
Searhc 1209 Behavioral
Sitka, AK 99835-7359
Phone (907) 966-8611

222 Tongass Dr
Sitka, AK 99835-9416
Phone (907) 966-2411

227 Tongass Dr
Sitka, AK 99835-9416
Phone (907) 966-2411

641 W Willoughby Ave
201 Searhc Internal Med
Juneau, AK 99801-1748
Phone (907) 586-8100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
666AKMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Alaska Regional Health Consortium CurrentSince Oct 25, 2004 Accepting new patients
Advantage Medical Group LLP Past Accepting new patients
Southeast Alaska Regional Health Consortium Past Accepting new patients

Locations

3100 Channel Dr
Ste 300
Juneau, AK 99801
Phone (907) 463-4000

222 Tongass Dr
Sitka, AK 99835
Phone (907) 966-8423

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CGFAAA/Endpoint/CGFAAA

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 36

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 36

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1003914391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "641 W WILLOUGHBY AVE",
            "address_2": "STE 201",
            "city": "JUNEAU",
            "state": "AK",
            "postal_code": "998011748",
            "telephone_number": "908-586-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3245 HOSPITAL DR",
            "city": "JUNEAU",
            "state": "AK",
            "postal_code": "998017809",
            "telephone_number": "907-463-4040",
            "fax_number": "907-463-6663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERICKSON",
        "first_name": "KELLY",
        "middle_name": "KATHLEEN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AK",
            "license": "666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID -TYPE UNSPECI",
            "identifier": "8EB370",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID -TYPE UNSPECI",
            "identifier": "8EB371",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-TYPE UNSPECIF",
            "identifier": "8EB373",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-TYPE UNSPECIF",
            "identifier": "8ED920",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-TYPE UNSPECIF",
            "identifier": "8EB372",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "HOLZER",
            "middle_name": "KATHLEEN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Juneau, AK

Sources for this page

Verify at the official NPI Registry.