Kimberly Marie Douglas, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

6568 Issued in AK

Practice address

436 5TH & Ted Stevens Way
Kotzebue, AK 99752-0043

Phone

(907) 442-3321

Fax

(907) 442-7250

NPI assigned

Sep 28, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Dr. Kimberly Marie Corral Former name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: kdouglas@direct.maniilaq.org

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.

• Maniilaq Association

  dba Maniilaq Health Center

  • Rural Acute Care Hospital
  • Kotzebue, AK
  • NPI 1861698805

  TX

  Medicare reassignment NPD
• Maniilaq Association

  dba Maniilaq Health Center

  • Critical Access Hospital
  • Kotzebue, AK
  • NPI 1316995210
  NPD
• Maniilaq Association

  dba Esther Barger Memorial Health Clinic

  • Federal Public Health Clinic/Center
  • Noatak, AK
  • NPI 1639446362
  NPD
• Maniilaq Association

  dba Maniilaq Health Center

  • Dentist
  • Kotzebue, AK
  • NPI 1003010042
  NPD (past)

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311897600000",
    "number": "1770675738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43",
            "city": "KOTZEBUE",
            "state": "AK",
            "postal_code": "997520043",
            "telephone_number": "907-223-4365",
            "fax_number": "907-442-7306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "436 5TH & TED STEVENS WAY",
            "city": "KOTZEBUE",
            "state": "AK",
            "postal_code": "997520043",
            "telephone_number": "907-442-3321",
            "fax_number": "907-442-7250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "KIMBERLY",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2011-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "6568",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HS19IP",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HS19OP",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "CORRAL",
            "middle_name": "MARIE",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Chantel Davis, RN
• Meredith A Dean, PHARMD
• Elsie Mary Dexter, HEALTH AIDE
• Elizabeth Ashley Diviney, LPC, CAADC, NCC
• Heather Dominguez
• Lois Douglas, BHA
• Shirley Renia Dukes, MA
• Victor E Ebenki, MA.CARS,BCCC,NCPRSS
• Carey D Eisen, MSW
• Rhonda H Eunice, LPN

• Family Medicine Physician in Kotzebue, AK
• Providers in Kotzebue, AK by specialty
• Family Medicine Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.