Ju-Lin Tham Fitzgibbon, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

116469 Issued in AK

Practice address

1717 W. Cowles Street
Fairbanks, AK 99701

Phone

(907) 451-6682

NPI assigned

Apr 28, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Ju-Lin Tham 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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ju-lin.fitzgibbon.1@15989.direct.athenahealth.com

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.

• Tanana Chiefs Conference

  • Multi-Specialty Clinic/Center
  • Fairbanks, AK
  • NPI 1821201278

  TX

  Medicare reassignment NPD

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

{
    "created_epoch": "1493337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635206400000",
    "number": "1831624741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2976 MOOSE MOUNTAIN RD",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997096072",
            "telephone_number": "617-932-9723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 W. COWLES STREET",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "99701",
            "telephone_number": "907-451-6682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZGIBBON",
        "first_name": "JU-LIN",
        "middle_name": "THAM",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-04-28",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "116469",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JU-LIN",
            "last_name": "THAM",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Dianna Fisher, LMT
• Douglas K Fisher
• Stephen Lee Fisher, M.D.
• Carrie Fisk
• Lacey Fisk
• Alicia B. Fitzpatrick, CDC I
• Edward J. Fitzpatrick, LCSW
• Will Flanders, AAS
• Kei Flechsing
• Cynthia Fleming, MSW

• Physician Assistant in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Physician Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2021; 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.