NPIMap

Individual provider Active NPI

Adriene Kim Fedde, MD

  • Family Medicine Physician
  • Petersburg, AK
National Provider Identifier
1609915636
Registry record updated Jun 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
7230 Issued in AK
Practice address
103 Fram Street
Petersburg, AK 99833
Phone
(505) 819-8996
NPI assigned
Feb 6, 2007
Last updated
Jun 22, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DR.0054942 CO
Family Medicine Physician 207Q00000X 7230 AK Primary

Addresses

Primary practice location

103 Fram Street
Petersburg, AK 99833

Mailing address

PO Box 150
Frisco, CO 80443-0150
Phone (505) 819-8996

Other practice location 1

10350 E Dakota Ave
Denver, CO 80247-1314
Phone (303) 338-4545

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20170228000895 CO Practitioner - Family Practice 4284791559 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain Family Health CentersGroup PAC ID 3173413101, 20 clinicians

Practice addresses (Care Compare)

123 Emma Rd
Basalt, CO 81621-9169
Phone (970) 945-2840

195 W
Rifle, CO 81650-4716
Phone (970) 945-2840

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
7230AKMDFamily Medicine Physician
DR.0054942COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain Family Health Centers Current Accepting new patients
Mountain Family Health Centers CurrentSince May 16, 2022 Accepting new patients
Mountain Family Health Centers CurrentSince May 16, 2022 Accepting new patients
Pueblo of Jemez Past Accepting new patients
Mountain Family Health Centers PastSince Feb 7, 2021 Accepting new patients

Locations

230 Chapel Sq
#D102
Avon, CO 81620

123 Emma Rd
Ste 106
Basalt, CO 81621

1905 Blake Ave
Ste 101
Glenwood Springs, CO 81601

195 W 14th St
Ste C
Rifle, CO 81650

Interoperability endpoints

  • Direct secure messaging: adriene.fedde.p1@direct.mfhc.nextgenshare.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624320000000",
    "number": "1609915636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 150",
            "city": "FRISCO",
            "state": "CO",
            "postal_code": "804430150",
            "telephone_number": "505-819-8996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 FRAM STREET",
            "city": "PETERSBURG",
            "state": "AK",
            "postal_code": "99833",
            "telephone_number": "505-819-8996"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10350 E Dakota Ave",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802471314",
            "country_code": "US",
            "telephone_number": "303-338-4545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FEDDE",
        "first_name": "ADRIENE KIM",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-06",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0054942",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "7230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "CAREQUALITY",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10350 E Dakota Ave",
            "city": "Denver",
            "state": "CO",
            "country_code": "US",
            "postal_code": "802471314",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Petersburg, AK

Sources for this page

Verify at the official NPI Registry.