Individual provider Active NPI

Kristina L Douglas, M.D.

  • Diagnostic Radiology Physician
  • Tucson, AZ
National Provider Identifier
1104916253
Registry record updated May 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
52500 Issued in AZ
Practice address
677 N Wilmot Rd
Tucson, AZ 85711-2701
Phone
(520) 795-2889
NPI assigned
Oct 12, 2006
Last updated
May 5, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X A81074 CA
Diagnostic Radiology Physician 2085R0202X 52500 AZ Primary

Addresses

Primary practice location

677 N Wilmot Rd
Tucson, AZ 85711-2701

Mailing address

700 E Morehead St Ste 300
Charlotte, NC 28202-2742

Other practice location 1

168 N Brent St
Suite 401
Ventura, CA 93003-2817
Phone (805) 652-5093

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NY, ID, AZ4 enrollments
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.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20061121000674 CA Practitioner - Diagnostic Radiology 3870591001 Reassigns benefits to 1 organization
I20260318000714 NY Practitioner - Diagnostic Radiology 3870591001 Reassigns benefits to 1 organization
I20260420002388 ID Practitioner - Diagnostic Radiology 3870591001 Reassigns benefits to 1 organization
I20260527000671 AZ Practitioner - Diagnostic Radiology 3870591001 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of California, Davis School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology LTD LLCGroup PAC ID 6204727589, 107 clinicians

Practice addresses (Care Compare)

Santa Barbara, CA 93111
Phone (520) 795-2889

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.69 of 100Reported as group
Quality
75.27
Improvement activities
40
Cost
74.3

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
81074CAMDMarriage & Family Therapist
52500AZMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Maiden Lane Medical, PLLC CurrentSince Feb 9, 2026 Accepting new patients
RLC LLC Diagnostic Radiology CurrentSince Sep 1, 2024 Accepting new patients
Assured Imaging Women's Wellness of Southern Arizona, LLC Diagnostic Radiology CurrentSince Nov 1, 2025 Accepting new patients
Radiology LTD., LLC Diagnostic Radiology CurrentSince Oct 1, 2023 Accepting new patients
Assured Imaging Women's Wellness of Southern Arizona, LLC Diagnostic Radiology CurrentSince Nov 1, 2025 Accepting new patients
Silicon Valley Diagnostic Imaging, Inc. Diagnostic Radiology PastSince Jun 11, 2023 Accepting new patients
Community Imaging Medical Group Inc Diagnostic Radiology Past Accepting new patients
Btdi JV, LLP PastSince Nov 1, 2023 Accepting new patients

Locations

677 N Wilmot Rd
Tucson, AZ 85711
Phone (520) 571-9599

7717 N Hartman Ln
Tucson, AZ 85743
Phone (520) 744-6121

700 E Morehead St
Ste 300
Charlotte, NC 28202
Phone (704) 442-4390

90 Maiden Ln
Fl 3
New York, NY 10038
Phone (646) 290-9560

Interoperability endpoints

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

Organizations & group practices 10

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": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746403200000",
    "number": "1104916253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 E MOREHEAD ST STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282022742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "677 N WILMOT RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857112701",
            "telephone_number": "520-795-2889"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "168 N Brent St",
            "address_2": "Suite 401",
            "address_purpose": "LOCATION",
            "city": "Ventura",
            "state": "CA",
            "postal_code": "930032817",
            "country_code": "US",
            "telephone_number": "805-652-5093",
            "fax_number": "805-641-3965",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "KRISTINA",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2025-05-05",
        "certification_date": "2025-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A81074",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AZ",
            "license": "52500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.