NPIMap

Individual provider Active NPI

Kirk Alan Butler, PA-C

  • Medical Physician Assistant
  • Flagstaff, AZ
National Provider Identifier
1760507065
Registry record updated Feb 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
4832 Issued in AZ
Practice address
525 N Switzer Canyon Dr
Flagstaff, AZ 86011-1483
Phone
(928) 773-2280
Fax
(928) 773-2281
NPI assigned
Mar 19, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 17, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 4832 AZ
Medical Physician Assistant 363AM0700X PA60051173 WA
Medical Physician Assistant 363AM0700X 4832 AZ Primary

Addresses

Primary practice location

525 N Switzer Canyon Dr
Flagstaff, AZ 86011-1483

Mailing address

525 N Switzer Canyon Dr
Flagstaff, AZ 86011-1483
Phone (928) 773-2280

Other identifiers 1

IdentifierTypeStateIssuer
610448MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20110922000173 AZ Practitioner - Physician Assistant 2860556974 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Flagstaff Center for Bone and Joint DisordersGroup PAC ID 3072411180, 28 clinicians

Practice addresses (Care Compare)

525 N Switzer Canyon Dr
Flagstaff, AZ 86001-4845
Phone (928) 773-2280

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. 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
Physician Assistant

State licenses

LicenseStateTypeSpecialty
4832AZMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Arizona Healthcare Corporation CurrentSince Sep 9, 2018 Accepting new patients
Northern Arizona Healthcare Corporation Orthopaedic Surgery CurrentSince Sep 9, 2018 Accepting new patients

Locations

269 S Candy Ln
Cottonwood, AZ 86326
Phone (928) 634-2251

1215 N Beaver St
Ste 203
Flagstaff, AZ 86001
Phone (928) 773-2249

1200 N Beaver St
Flagstaff, AZ 86001
Phone (928) 213-6235

1485 N Turquoise Dr
Flagstaff, AZ 86001
Phone (928) 774-6626

Interoperability endpoints

  • Direct secure messaging: kirk.butler.1@15940.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 9

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": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645056000000",
    "number": "1760507065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 N SWITZER CANYON DR",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860111483",
            "telephone_number": "928-773-2280",
            "fax_number": "928-773-2281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 N SWITZER CANYON DR",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860111483",
            "telephone_number": "928-773-2280",
            "fax_number": "928-773-2281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTLER",
        "first_name": "KIRK",
        "middle_name": "ALAN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-19",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "AZ",
            "license": "4832",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA60051173",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "4832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "610448",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

Verify at the official NPI Registry.