Jennifer Kathleen Malcolm, D.O.

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

05-37550 Issued in KS

Practice address

1105 Sunset Ave
Manhattan, KS 66502-3739

Phone

(785) 532-6544

Fax

(785) 532-3425

NPI assigned

Jun 25, 2008

Last updated

Sep 5, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AK

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 1

Specialty

Family PracticeAlso: Sports Medicine

Education

Philadelphia College of Osteopathic Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

McKinley Sports Medicine LLCGroup PAC ID 8123309465, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Fairbanks Memorial Hospital Hospital, Fairbanks, AK, CCN 020012

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mckinleyorthopedics.jennifermalcom@158245.advancedmd-direct.com

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.

• McKinley Sports Medicine, LLC

  • Sports Medicine (Family Medicine) Physician
  • Fairbanks, AK
  • NPI 1407304017
  Medicare reassignment Care Compare group NPD Authorized official
• McKinley Imaging, LLC

  • Radiology Clinic/Center
  • Fairbanks, AK
  • NPI 1780340836
  NPD

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

• Fairbanks Memorial Hospital, LLC

  • General Acute Care Hospital
  • Fairbanks, AK
  • NPI 1720537178
  Care Compare affiliation

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

{
    "created_epoch": "1214352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409875200000",
    "number": "1154583862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 SUNSET AVE",
            "city": "MANHATTAN",
            "state": "KS",
            "postal_code": "665023739",
            "telephone_number": "785-532-6544",
            "fax_number": "785-532-3425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 SUNSET AVE",
            "city": "MANHATTAN",
            "state": "KS",
            "postal_code": "665023739",
            "telephone_number": "785-532-6544",
            "fax_number": "785-532-3425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALCOLM",
        "first_name": "JENNIFER",
        "middle_name": "KATHLEEN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-25",
        "last_updated": "2014-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "IN",
            "license": "02003812A",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "KS",
            "license": "05-37550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura K Magallanes, COTA/L
• Sheri D. Mahan, OTR/L
• Chaz D Mailey, PSY.D.
• Megan Major
• Ian Malburg, MD
• Mark Anthony Maldonado
• Ashley Malmquist, LPC
• Amanda C a Malone
• Kelley Nicole Maneage, DC, L.A.T
• Cade Dylan Mangan I

• Sports Medicine (Family Medicine) Physician in Manhattan, KS
• Providers in Manhattan, KS by specialty
• Sports Medicine (Family Medicine) Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2014; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.