NPIMap

Individual provider Active NPI

Kristen R Burkholder, MD

  • Family Medicine Physician
  • Shonto, AZ
National Provider Identifier
1083795108
Registry record updated Dec 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
41592 Issued in AZ
Practice address
Hwy 98 & Navajo Route 16
Shonto, AZ 86044-7397
Phone
(928) 672-3000
Fax
(928) 697-3005
NPI assigned
Oct 17, 2006
Last updated
Dec 23, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 41592 AZ Primary

Addresses

Primary practice location

Hwy 98 & Navajo Route 16
Shonto, AZ 86044-7397

Mailing address

PO Box 368
Kayenta, AZ 86033-0368
Phone (928) 697-4000

Other identifiers 1

IdentifierTypeStateIssuer
981482MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051222000638 TX Practitioner - Family Practice 4981626553 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

167 Main St
Tcrhcc Mobile Medical Clinic
Tuba City, AZ 86045-0600
Phone (928) 283-2501

167 N Main St
Tuba City, AZ 86045-0600
Phone (928) 283-2094

P O Box
Suite 600
Tuba City, AZ 86045-0600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.59 of 100Reported as group
Quality
47.51
Promoting interoperability
69
Improvement activities
40
Cost
86.96

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Tuba City Regional Health Care Corporation Family Medicine CurrentSince Mar 1, 2024 Accepting new patients
Kayenta Alternative Rural Hospital CurrentSince Dec 9, 2019 Accepting new patients
DHHS IHS Phoenix CurrentSince Nov 5, 2021 Accepting new patients
DHHS IHS Phoenix Area CurrentSince Nov 5, 2021 Accepting new patients
DHHS IHS Phoenix Area CurrentSince Oct 30, 2021 Accepting new patients
DHHS PHS Naihs Chinle Comprehensive Health Care Facility CurrentSince Jul 29, 2013 Accepting new patients
DHHS PHS Naihs Chinle Comprehensive Health Care Facility Current Accepting new patients
Tuba City Regional Health Care Corporation Family Medicine Current Accepting new patients
Tuba City Regional Health Care Corporation Family Medicine CurrentSince Mar 1, 2024 Accepting new patients
Kayenta Alternative Rural Hospital CurrentSince Dec 9, 2019 Accepting new patients
DHHS IHS Phoenix Area CurrentSince Oct 30, 2021 Accepting new patients
DHHS PHS Naihs Chinle Comprehensive CurrentSince Jul 29, 2013 Accepting new patients

Locations

12033 Agency Rd
Parker, AZ 85344
Phone (760) 572-4137

Organizations & group practices 12

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577059200000",
    "number": "1083795108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 368",
            "city": "KAYENTA",
            "state": "AZ",
            "postal_code": "860330368",
            "telephone_number": "928-697-4000",
            "fax_number": "928-697-4052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HWY 98 & NAVAJO ROUTE 16",
            "city": "SHONTO",
            "state": "AZ",
            "postal_code": "860447397",
            "telephone_number": "928-672-3000",
            "fax_number": "928-697-3005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURKHOLDER",
        "first_name": "KRISTEN",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2019-12-23",
        "certification_date": "2019-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "41592",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "981482",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shonto, AZ

Sources for this page

Verify at the official NPI Registry.