Individual provider Active NPI

Kevin Michael Fire, PH.D.

  • Audiologist
  • Grand Forks, ND
National Provider Identifier
1861595753
Registry record updated Oct 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
441 Issued in ND
Practice address
121 North Washington Street
Grand Forks, ND 58203-3400
Phone
(701) 787-5862
Fax
(701) 738-2371
NPI assigned
Sep 6, 2006
Last updated
Oct 16, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 16, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 441 ND Primary

Addresses

Primary practice location

121 North Washington Street
Grand Forks, ND 58203-3400

Mailing address

121 North Washington Street
Grand Forks, ND 58203-3400
Phone (701) 787-5862

Other identifiers 3

IdentifierTypeStateIssuer
51100MedicaidND
1G724FIOtherMNBCBS
FIR19598OtherNDBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080619000213 ND Practitioner - Qualified Audiologist 9931270956 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

121 N Washington St
Grand Forks, ND 58203-3400
Phone (701) 787-5862

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Quotable Kids Pediatric Therapy Clinic, PLLC CurrentSince Jun 19, 2013 Accepting new patients

Locations

121 N Washington St
Grand Forks, ND 58203
Phone (701) 739-5437

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350345600000",
    "number": "1861595753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 NORTH WASHINGTON STREET",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582033400",
            "telephone_number": "701-787-5862",
            "fax_number": "701-738-2371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 NORTH WASHINGTON STREET",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582033400",
            "telephone_number": "701-787-5862",
            "fax_number": "701-738-2371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FIRE",
        "first_name": "KEVIN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2012-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "ND",
            "license": "441",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "51100",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1G724FI",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "FIR19598",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.