NPIMap

Individual provider Active NPI

Jesse Jennings Kincaid, M.D.

  • Neuroradiology Physician
  • Soldotna, AK
National Provider Identifier
1093835829
Registry record updated Dec 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuroradiology PhysicianTaxonomy code 2085N0700X
License
6363 Issued in AK
Practice address
250 Hospital PL
Soldotna, AK 99669-7559
Phone
(907) 714-4580
Fax
(907) 714-4995
NPI assigned
Mar 29, 2007
Last updated
Dec 4, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neuroradiology Physician 2085N0700X 6363 AK Primary
Diagnostic Radiology Physician 2085R0202X MD00049249 WA

Addresses

Primary practice location

250 Hospital PL
Soldotna, AK 99669-7559

Mailing address

250 Hospital PL
Soldotna, AK 99669-7559
Phone (907) 714-4580

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, 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
I20080616000790 WA Practitioner - Diagnostic Radiology 6103997333 Reassigns benefits to 9 organizations
I20081010000175 AK Practitioner - Diagnostic Radiology 6103997333 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Washington School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Star Medical Imaging PLLCGroup PAC ID 7214005099, 30 clinicians
Skagit Digital Imaging LLCGroup PAC ID 4486543204, 29 clinicians
Bellingham Advanced Medical Imaging LLCGroup PAC ID 9739446824, 27 clinicians
Skagit Radiology Inc P SGroup PAC ID 7113815218, 39 clinicians
Fairbanks Medical Imaging LLCGroup PAC ID 4082894407, 28 clinicians

Practice addresses (Care Compare)

101 N Main St
Coupeville, WA 98239-3413

1211 24TH St
Anacortes, WA 98221-2562
Phone (360) 678-5151

1320 E Division St
Mount Vernon, WA 98274-4133
Phone (360) 424-6161

1344 King St
Suite 101
Bellingham, WA 98229-6215
Phone (360) 424-6161

1415 E Kincaid St
Mount Vernon, WA 98274-4126
Phone (360) 424-6161

2310 Peger Rd
Suite 102
Fairbanks, AK 99709-5305
Phone (360) 424-6161

250 Hospital PL
Soldotna, AK 99669-7559
Phone (360) 678-5151

325 Ridgewood Dr
Soldotna, AK 99669-7358
Phone (907) 459-6565

834 Sheridan St
Port Townsend, WA 98368-2443
Phone (360) 385-2200

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Star Medical Imaging PLLC Diagnostic Radiology CurrentSince Jul 14, 2008 Accepting new patients
Public Hospital District No 2 Skagit County Washington CurrentSince Jun 28, 2009 Accepting new patients
Public Hospital District No 2 Skagit County Washington CurrentSince Jun 28, 2009 Accepting new patients
Jefferson County Public Hospital District No 2 CurrentSince Nov 1, 2022 Accepting new patients
Iliuliuk Family and Health Services Inc CurrentSince May 1, 2023 Accepting new patients
Whidbey Island Public Hospital District CurrentSince Jun 1, 2020 Accepting new patients
Fairbanks Medical Imaging LLC Diagnostic Radiology CurrentSince Jan 1, 2011 Accepting new patients
Whidbey Island Public Hospital District CurrentSince Jun 1, 2020 Accepting new patients
Western Washington Medical Group, Inc PS CurrentSince Sep 1, 2016 Accepting new patients
Bellingham Advanced Medical Imaging LLC Diagnostic Radiology CurrentSince Aug 21, 2017 Accepting new patients
Public Hospital District No 2 Skagit County Washington Current Accepting new patients
Whidbey Island Public Hospital District Neuroradiology CurrentSince Jun 1, 2020 Accepting new patients
Skagit Radiology Inc P S Diagnostic Radiology CurrentSince Jul 1, 2008 Accepting new patients
Iliuliuk Family &Health Services, Inc. Past Accepting new patients

Locations

2310 Peger Rd
Ste 102
Fairbanks, AK 99709

250 Hospital Pl
Soldotna, AK 99669
Phone (907) 714-4404

1211 24th St
Anacortes, WA 98221
Phone (360) 293-3181

1344 King St
Ste 101
Bellingham, WA 98229
Phone (360) 676-6393

101 N Main St
Coupeville, WA 98239
Phone (360) 678-7656

125 N 18th St
Ste C
Mount Vernon, WA 98273
Phone (360) 428-7274

1320 E Division St
Mount Vernon, WA 98274
Phone (360) 424-9607

1400 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 428-2586

1415 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 416-5750

1200 W Sims Way
Ste C
Port Townsend, WA 98368
Phone (360) 385-6297

834 Sheridan St
Port Townsend, WA 98368
Phone (360) 344-0400

2000 Hospital Dr
Sedro Woolley, WA 98284
Phone (360) 856-6021

Interoperability endpoints

  • Direct secure messaging: jkincaid12534@skagit.direct-ci.com

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Central Peninsula General HospitalSoldotna, AK, CCN 020024 Hospital Corporate Director Jan 1, 2022
Central Peninsula General HospitalSoldotna, AK, CCN 02U024 Hospital Corporate Director Jan 1, 2022
Heritage PlaceSoldotna, AK, CCN 025021 Skilled nursing facility Corporate Director Jan 1, 2022

Owned or controlled facilities with NPI records 20

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 20

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575417600000",
    "number": "1093835829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 HOSPITAL PL",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996697559",
            "telephone_number": "907-714-4580",
            "fax_number": "907-714-4995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 HOSPITAL PL",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996697559",
            "telephone_number": "907-714-4580",
            "fax_number": "907-714-4995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINCAID",
        "first_name": "JESSE",
        "middle_name": "JENNINGS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-29",
        "last_updated": "2019-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "AK",
            "license": "6363",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "MD00049249",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Soldotna, AK

Sources for this page

Verify at the official NPI Registry.