Carol Juergens, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

AA1786 Issued in AK

Practice address

1818 E Rezanof Dr
Kodiak, AK 99615

Phone

(907) 486-6065

Fax

(907) 486-2248

NPI assigned

Mar 14, 2006

Sex

Female

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Kodiak Island Medical Associates LLC

  • Multi-Specialty Clinic/Center
  • Kodiak, AK
  • NPI 1770529794
  NPD (past)

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512518400000",
    "number": "1174591325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8689",
            "city": "KODIAK",
            "state": "AK",
            "postal_code": "996158689",
            "telephone_number": "907-486-6065",
            "fax_number": "907-486-2248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 E REZANOF DR",
            "city": "KODIAK",
            "state": "AK",
            "postal_code": "99615",
            "telephone_number": "907-486-6065",
            "fax_number": "907-486-2248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUERGENS",
        "first_name": "CAROL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-14",
        "last_updated": "2017-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AK",
            "license": "AA1786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0173",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD1786",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amie K Jones, BHC II, CDC I
• Evan John Jones II, MD
• Shana J Jones, RN
• Phillip Anthony Jordinelli, CDCS, NCACI, SAP
• Carolyn Judd, LMT
• Julie Kaiser, BHA-I
• Kaliedoscope Assisted Living Home
• Marita - Kaplan
• Kimberly Katelnikoff
• Margaret Kavanaugh

• Internal Medicine Physician in Kodiak, AK
• Providers in Kodiak, AK by specialty
• Internal Medicine Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.