Active NPI
Paul A Forward, MD
- Family Medicine Physician
- Kodiak, AK
National Provider Identifier
1962639617
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 7487
- Practice address
- 1915 Rezanof Dr E
Kodiak, AK 99615-6602 - Phone
- (907) 486-3781
- Fax
- (907) 486-9586
- NPI assigned
- Jun 19, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 7487 | AK | Primary |
Addresses
Primary practice location
1915 Rezanof Dr E
Kodiak, AK 99615-6602
Mailing address
PO Box 3706
Portland, OR 97208-3706
Phone (866) 907-1068
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1009501 | Medicaid | AK |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7487 | AK | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maniilaq Association | Current | Accepting new patients | |
| Alaska Native Tribal Health Consortium | Current | Accepting new patients | |
| Maniilaq Association | Current | Accepting new patients | |
| Maniilaq Association | Current | Accepting new patients |
Locations
4315 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-1729
Interoperability endpoints
- pforward@direct.maniilaq.org
Organizations & group practices 4
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.
-
- Critical Access Hospital
- Kotzebue, AK
- NPI 1316995210
-
- Federal Public Health Clinic/Center
- Ambler, AK
- NPI 1427325133
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453680000000",
"number": "1962639617",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3706",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972083706",
"telephone_number": "866-907-1068",
"fax_number": "425-917-9141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1915 REZANOF DR E",
"city": "KODIAK",
"state": "AK",
"postal_code": "996156602",
"telephone_number": "907-486-3781",
"fax_number": "907-486-9586"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORWARD",
"first_name": "PAUL",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-06-19",
"last_updated": "2016-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AK",
"license": "7487",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1009501",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kodiak, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2016; 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.