Kim Edward Thiele, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MEDO4125 Issued in AK

Practice address

36901 Mallard Rd
Kenai, AK 99611-6434

Phone

(907) 283-5000

Fax

(907) 283-5013

NPI assigned

Jan 12, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective May 27, 2016 through May 27, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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

• Kim Thiele, DO, PC

  • Primary Care Clinic/Center
  • Kenai, AK
  • NPI 1972894418
  NPD (past) Authorized official

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574208000000",
    "number": "1043361629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36901 MALLARD RD",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "996116434",
            "telephone_number": "907-283-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36901 MALLARD RD",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "996116434",
            "telephone_number": "907-283-5000",
            "fax_number": "907-283-5013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIELE",
        "first_name": "KIM",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-12",
        "last_updated": "2019-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "MEDO4125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013951",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mischele Emerson Taylor
• Erys Katherine Tea, LCSW
• Brendan Trevor Teague-Glover
• Michelle Jenee Teates
• Star Ellen Theodore
• Chelsie Thompson
• Kristin Thompson
• Teresa E Thompson, DNP, APRN, FNP-BC
• Three Bears Alaska, Inc
• Timothy Gillis LPC

• Family Medicine Physician in Kenai, AK
• Providers in Kenai, AK by specialty
• Family Medicine Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.