Kimberly Jean Stark-Van Noord, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601004641 Issued in MI

Practice address

44021 Dequindre
Ferndale, MI 48085

Phone

(248) 964-8787

Fax

(248) 964-6133

NPI assigned

Jul 19, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

89.77 of 100Reported as group

Quality

91.47

Promoting interoperability

100

Improvement activities

40

Cost

74.42

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• University of Utah Adult Services

  • General Practice Physician
  • Salt Lake City, UT
  • NPI 1114321981
  Medicare reassignment
• University of Utah Adult Services

  • Diagnostic Radiology Physician
  • Salt Lake City, UT
  • NPI 1598169419
  NPD
• University of Utah Adult Services

  • Hepatology Physician
  • Salt Lake City, UT
  • NPI 1780088583
  NPD
• University of Utah Emergency Physicians

  • Emergency Medical Services (Emergency Medicine) Physician
  • Salt Lake City, UT
  • NPI 1093769218
  NPD (past)
• University of Utah Emergency Physicians

  • Emergency Medicine Physician
  • Rock Springs, WY
  • NPI 1730583295
  NPD (past)

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

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637280000000",
    "number": "1497955397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44021 DEQUINDRE",
            "address_2": "ATTN JAN MCFARLANE",
            "city": "TROY",
            "state": "MI",
            "postal_code": "48085",
            "telephone_number": "248-964-8787",
            "fax_number": "248-964-6133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44021 DEQUINDRE",
            "city": "FERNDALE",
            "state": "MI",
            "postal_code": "48085",
            "telephone_number": "248-964-8787",
            "fax_number": "248-964-6133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK-VAN NOORD",
        "first_name": "KIMBERLY",
        "middle_name": "JEAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-19",
        "last_updated": "2021-11-19",
        "certification_date": "2021-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004641",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF",
            "identifier": "0F31794",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL INSURANCE",
            "identifier": "383601519",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kstarkvannoord66419@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Melissa Squirewell
• David Gregory St. John, PHD, LP
• Margaret Ann Stack, PH.D., APBB
• Stacy Wright PLLC
• Stacie Irene Stafford, TLLP
• Stephanie Diponio Therapy & Consulting
• Stephanie Williams, PHD, LP, PLLC
• Dionne Stewart, LMT
• Rachel Renee Stewart, LLPC, ATR-P
• Tara Lynn Stock, DPM

• Physician Assistant in Ferndale, MI
• Providers in Ferndale, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.