Lubov M Coverdell, M.D. – Specialist

Key facts

NPI: 1578614756
Entity type: Individual (NPI type 1)
Primary specialty: Specialist 174400000X
License: AK5172 (AK)
Practice address: 11470 Business Blvd
Ste 100
Eagle River, AK 99577-7721
Phone: (907) 622-4325
Fax: (907) 622-4326
NPI assigned: Jan 15, 2007
Sex: Female
Sole proprietor: No

Organizations & group practices 1

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.

Acute Family Medicine Clinic Inc Family Medicine Physician · Eagle River, AK · NPI 1679704688

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Opted out of Medicare: Yes, effective Jul 14, 2013 through Jul 14, 2027

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
AK5172	AK	MD	Specialist

Practice roles

Organization	Specialty	Status	New patients
Acute Family Medicine Clinic Inc		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Specialist	174400000X	AK5172	AK	Yes

Addresses

Primary practice location

11470 Business Blvd
Ste 100
Eagle River, AK 99577-7721

Mailing address

11470 Business Blvd
Ste 100
Eagle River, AK 99577-7721
Phone (907) 622-4325

Other identifiers

Identifier	Type	State	Issuer
MD5172	Medicaid	AK
AK5172	Other	AK	AK STATE LICENSE
MD51721	Medicaid	AK

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 9, 2007.

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1578614756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11470 BUSINESS BLVD",
            "address_2": "STE 100",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995777721",
            "telephone_number": "907-622-4325",
            "fax_number": "907-622-4326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11470 BUSINESS BLVD",
            "address_2": "STE 100",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995777721",
            "telephone_number": "907-622-4325",
            "fax_number": "907-622-4326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COVERDELL",
        "first_name": "LUBOV",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-15",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AK",
            "license": "AK5172",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD5172",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AK STATE LICENSE",
            "identifier": "AK5172",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD51721",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle River, AK

All providers in Eagle River, AK · Specialist in Alaska

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Opt Out Affidavits (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.