Kymberli Raye Brock, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1073 Issued in AK

Practice address

3841 Piper St
Suite T100
Anchorage, AK 99508-4624

Phone

(907) 561-3211

Fax

(907) 562-7547

NPI assigned

Jun 17, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in AK

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

Specialty

Nurse Practitioner

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Select Physical Therapy Holdings IncGroup PAC ID 9537076401, 1,992 clinicians

Moose Creek Medical Clinic LLCGroup PAC ID 0143554188, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ancora Home Health & Hospice Home health agency, Wasilla, AK, CCN 027008
• Mat-Su Regional Medical Center Hospital, Palmer, AK, CCN 020006

Merit-based Incentive Payment System (MIPS)

Final score

49.2 of 100Reported as group

Quality

0

Improvement activities

40

Cost

61.47

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Moose Creek Medical Clinic LLC

  • Adult Health Nurse Practitioner
  • Wasilla, AK
  • NPI 1053883595

  Adult Health, AK

  Medicare reassignment Care Compare group NPD

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

• Ancora Home Health & Hospice, LLC

  • Home Health Agency
  • Wasilla, AK
  • NPI 1801380043
  Care Compare affiliation
• Mat-Su Valley Medical Center LLC

  • General Acute Care Hospital
  • Palmer, AK
  • NPI 1417975061

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383004800000",
    "number": "1619972478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3841 PIPER ST",
            "address_2": "SUITE T100",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084624",
            "telephone_number": "907-561-3211",
            "fax_number": "907-562-7547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3841 PIPER ST",
            "address_2": "SUITE T100",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084624",
            "telephone_number": "907-561-3211",
            "fax_number": "907-562-7547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCK",
        "first_name": "KYMBERLI",
        "middle_name": "RAYE",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-17",
        "last_updated": "2013-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "ID",
            "license": "NP-586A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AK",
            "license": "1073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010147885",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1022256",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806735600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Russell Lee Britton
• Bradley Brock
• David H Brock, PHD
• Heather Ellison Brock, ANP
• Jasmine Brock, MD
• Stuart Brock
• Kristi Brockman
• Richard E Brodsky, MD
• Jeanieann Jen Brogden, RN
• Valerie Brogden

• All providers in Anchorage, AK
• Family Nurse Practitioner in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2013; 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.