McKinley Sports Medicine, LLC

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

10040231 Issued in AK

Legal business name

MCKINLEY SPORTS MEDICINE, LLC

Practice address

3745 Geist Rd
Fairbanks, AK 99709-3554

Phone

(907) 456-3341

Fax

(907) 456-3443

NPI assigned

Sep 13, 2016

Organization subpart

No

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

Authorized official

Name

Jennifer K Malcolm, DONPI 1154583862

Title

President

Phone

(907) 456-3341

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AK

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Kathleen Malcolm, D.O.

  • Sports Medicine (Family Medicine) Physician
  • Manhattan, KS
  • NPI 1154583862

  AK

  Medicare reassignment Care Compare group NPD Authorized official
• Bethany V Chernich, D.O.

  • Family Medicine Physician
  • Fairbanks, AK
  • NPI 1598950545
  Medicare reassignment Care Compare group
• Benjamin Douglas Johnson, PA-C, R.T. (R)

  • Radiology Practitioner Assistant
  • Fairbanks, AK
  • NPI 1821516345
  Medicare reassignment

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

{
    "created_epoch": "1473724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473724800000",
    "number": "1407304017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3745 GEIST RD",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997093554",
            "telephone_number": "907-456-3341",
            "fax_number": "907-456-3443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3745 GEIST RD",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997093554",
            "telephone_number": "907-456-3341",
            "fax_number": "907-456-3443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCKINLEY SPORTS MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-13",
        "last_updated": "2016-09-13",
        "status": "A",
        "authorized_official_last_name": "MALCOLM",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "907-456-3341",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": "AK",
            "license": "10040231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth McKay
• Kailea-Ann Jolea McKee
• Tatyana Dominique McKenzie
• McKinley Imaging, LLC
• McKinley Orthopedic and Sports Medicine, LLC
• McKinley Surgery Center, LLC
• Richard Paul McKinley, O.D.
• Alissa McKnight
• Kelly McLachlan
• Susan Annette McLane

• Sports Medicine (Family Medicine) Physician in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Sports Medicine (Family Medicine) Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.