NPIMap

Individual provider Active NPI

Kimberly Fairley, MD

  • Family Medicine Physician
  • Montezuma Creek, UT
National Provider Identifier
1235214289
Registry record updated Mar 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
61094641205 Issued in UT
Practice address
1478 East Highway 162
Montezuma Creek, UT 84511
Phone
(435) 651-3700
Fax
(435) 678-0608
NPI assigned
Oct 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2022

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 61094641205 UT Primary

Addresses

Primary practice location

1478 East Highway 162
Montezuma Creek, UT 84511

Mailing address

PO Box 130
Montezuma Creek, UT 84534-0130
Phone (435) 651-3291

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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
I20070117000076 UT Practitioner - Family Practice 4981605045 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Colorado School of Medicine, Denver, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2 Rainbow Rd
Navajo Mountain, UT 84511-3910
Phone (928) 672-2498

802 S 200
Blanding, UT 84511-3910
Phone (435) 678-3601

East Hwy 262
Montezuma Creek, UT 84534-0130
Phone (435) 651-3700

PO Box
Montezuma Creek, UT 84534

PO Box
Montezuma Creek, UT 84534-0130

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
61094641205UTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Utah Navajo Health System, Incorporated Family Medicine CurrentSince Jun 1, 2006 Accepting new patients
Utah Navajo Health System, Incorporated Family Medicine Past Accepting new patients
Utah Navajo Health System, Incorporated Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kimberly.fairley.1@16098.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 11

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": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647561600000",
    "number": "1235214289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "MONTEZUMA CREEK",
            "state": "UT",
            "postal_code": "845340130",
            "telephone_number": "435-651-3291",
            "fax_number": "435-651-3376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1478 EAST HIGHWAY 162",
            "city": "MONTEZUMA CREEK",
            "state": "UT",
            "postal_code": "84511",
            "telephone_number": "435-651-3700",
            "fax_number": "435-678-0608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRLEY",
        "first_name": "KIMBERLY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-26",
        "last_updated": "2022-03-18",
        "certification_date": "2022-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "61094641205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montezuma Creek, UT

Sources for this page

Verify at the official NPI Registry.