NPIMap

Organization Active NPI

Eagle River Pain & Wellness, LLC

  • Nurse Practitioner
  • Eagle River, AK
National Provider Identifier
1003255480
Registry record updated Jun 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
308947 Issued in AK
Legal business name
EAGLE RIVER PAIN & WELLNESS, LLC
Practice address
16425 Brooks Loop
Eagle River, AK 99577-8027
Phone
(907) 622-4673
Fax
(907) 622-4674
NPI assigned
Jun 19, 2013
Last updated
Jun 20, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2014

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

Authorized official

Name
Mrs. Jessica Joyce Spayd, ANPNPI 1386602019
Title
Owner
Phone
(907) 622-4673

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 308947 AK Primary

Addresses

Primary practice location

16425 Brooks Loop
Eagle River, AK 99577-8027

Mailing address

16425 Brooks Loop
Eagle River, AK 99577-8027
Phone (907) 622-4673

Other identifiers 1

IdentifierTypeStateIssuer
1584697MedicaidAK

National Provider Directory

National Provider Directory

Locations

16425 Brooks Loop
Eagle River, AK 99577
Phone (907) 622-4673

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1371600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403222400000",
    "number": "1003255480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16425 BROOKS LOOP",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995778027",
            "telephone_number": "907-622-4673",
            "fax_number": "907-622-4674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16425 BROOKS LOOP",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995778027",
            "telephone_number": "907-622-4673",
            "fax_number": "907-622-4674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE RIVER PAIN & WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-19",
        "last_updated": "2014-06-20",
        "status": "A",
        "authorized_official_last_name": "SPAYD",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "JOYCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-622-4673",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "ANP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AK",
            "license": "308947",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1584697",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle River, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.