NPIMap

Individual provider Active NPI

Georgia Blackwood Kubic, M.D.

  • Family Medicine Physician
  • Salt Lake City, UT
National Provider Identifier
1235429655
Registry record updated Aug 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
8406695-1205 Issued in UT
Practice address
375 Chipeta Way
University of Utah Family Medicine Residency
Salt Lake City, UT 84108-1260
Phone
(801) 587-3411
NPI assigned
Apr 19, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2014

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 8406695-1205 UT Primary

Addresses

Primary practice location

375 Chipeta Way
University of Utah Family Medicine Residency
Salt Lake City, UT 84108-1260

Mailing address

2232 Haversham Close
Virginia Beach, VA 23454-1151
Phone (757) 630-4046

Other names 1

  • Georgia Leeann Blackwood Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20141203000295 TX Practitioner - Family Practice 7911139761 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Virginia Commonwealth University, School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Alaska Native Tribal Health ConsortiumGroup PAC ID 6709780265, 605 clinicians

Practice addresses (Care Compare)

3801 University Lake Dr
Anchorage, AK 99508-4658
Phone (907) 563-2662

3976 University Lake Dr
Suite 100
Anchorage, AK 99508-4644
Phone (907) 563-2662

4315 Diplomacy Dr
Anchorage, AK 99508-5926
Phone (907) 563-2662

4320 Diplomacy Dr
Anchorage, AK 99508-5925
Phone (907) 265-4955

Hospital & facility affiliations

  • Alaska Native Medical Center Hospital, Anchorage, AK, CCN 020026

Merit-based Incentive Payment System (MIPS)

Final score
90.93 of 100Reported as group
Quality
70.1
Promoting interoperability
100
Improvement activities
40
Cost
83.01

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
8406695-1205UTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alaska Native Tribal Health Consortium CurrentSince Oct 22, 2014 Accepting new patients
Southcentral Foundation CurrentSince Oct 22, 2014 Accepting new patients
Southcentral Foundation Current Accepting new patients
Southcentral Foundation Current Accepting new patients
Southcentral Foundation CurrentSince Oct 22, 2014 Accepting new patients

Locations

4315 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-1729

4320 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-0000

1 Flight Line Rd
Port Alsworth, AK 99653
Phone (907) 781-2256

Interoperability endpoints

  • Direct secure messaging: gkubic@direct.scf.cc

Organizations & group practices 5

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1303171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408492800000",
    "number": "1235429655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2232 HAVERSHAM CLOSE",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234541151",
            "telephone_number": "757-630-4046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 CHIPETA WAY",
            "address_2": "UNIVERSITY OF UTAH FAMILY MEDICINE RESIDENCY",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081260",
            "telephone_number": "801-587-3411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBIC",
        "first_name": "GEORGIA",
        "middle_name": "BLACKWOOD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-19",
        "last_updated": "2014-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "8406695-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GEORGIA",
            "last_name": "BLACKWOOD",
            "middle_name": "LEEANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.