Active NPI
Mary Elizabeth Kirker, M.D.
- Family Medicine Physician
- Longmont, CO
National Provider Identifier
1316903933
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 30215
- Practice address
- 630 15TH Ave
#103
Longmont, CO 80501-2700 - Phone
- (303) 776-0600
- Fax
- (303) 776-0778
- NPI assigned
- Apr 22, 2006
- Last updated
- Dec 3, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 30215 | CO | Primary |
Addresses
Primary practice location
630 15TH Ave
#103
Longmont, CO 80501-2700
Mailing address
630 15TH Ave
#103
Longmont, CO 80501-2700
Phone (303) 776-0600
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0007735394 | Other | CO | AETNA |
| 01302157 | Medicaid | CO | |
| 2949706 | Other | CO | AETNA HMO |
| 4218151 | Other | CO | CIGNA |
| 659985 | Other | CO | BCBS-FEDERAL |
| 5502AMGR007598 | Other | CO | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30215 | CO | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196640000000",
"number": "1316903933",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 15TH AVE",
"address_2": "#103",
"city": "LONGMONT",
"state": "CO",
"postal_code": "805012700",
"telephone_number": "303-776-0600",
"fax_number": "303-776-0778"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 15TH AVE",
"address_2": "#103",
"city": "LONGMONT",
"state": "CO",
"postal_code": "805012700",
"telephone_number": "303-776-0600",
"fax_number": "303-776-0778"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRKER",
"first_name": "MARY",
"middle_name": "ELIZABETH",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-04-22",
"last_updated": "2007-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CO",
"license": "30215",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0007735394",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01302157",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO",
"identifier": "2949706",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "4218151",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS-FEDERAL",
"identifier": "659985",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "5502AMGR007598",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Longmont, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.