Daniel John Coverdell, M.D.
Individual provider Active NPI Specialist · Eagle River, AK
NPI 1609936004 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1609936004
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 4780 (AK)
- Practice address
- 11470 Business Blvd
Suite 100
Eagle River, AK 99577-7721 - Phone
- (907) 622-4325
- Fax
- (907) 622-4326
- NPI assigned
- Dec 8, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
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 Jan 1, 2014 through Jan 1, 2028
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
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 | 4780 | AK | Yes |
Addresses
Primary practice location
11470 Business Blvd
Suite 100
Eagle River, AK 99577-7721
Mailing address
15217 Darby Rd
Eagle River, AK 99577-9211
Phone (907) 622-5584
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MD63211 | Medicaid | AK | |
| MD6231 | Medicaid | AK | |
| 4780 | Other | AK | STATE LICENSE # |
Other providers in Eagle River, AK
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.