Keith Poorbaugh, PT, SCD, OCS, FAAOMP

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1581 Issued in AK

Practice address

984 N Meridian PL
# A
Wasilla, AK 99654-7215

Phone

(907) 631-4029

Fax

(907) 631-4128

NPI assigned

Dec 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AK

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Mayo Medical School, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northern Edge Physical Therapy Limited PartnershipGroup PAC ID 7315394996, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Northern Edge Physical Therapy Limited Partnership

  • Physical Therapist
  • Wasilla, AK
  • NPI 1497538474
  Medicare reassignment Care Compare group NPD
• Newak, LLC

  • Physical Therapist
  • Wasilla, AK
  • NPI 1811499049
  NPD Authorized official
• Advanced Physical Therapy Inc

  • Physical Therapist
  • Anchorage, AK
  • NPI 1437214459
  NPD (past)

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1003971037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "984 NORTH MERIDIAN PL",
            "address_2": "A",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547215",
            "telephone_number": "907-631-4029",
            "fax_number": "907-631-4128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "984 N MERIDIAN PL",
            "address_2": "# A",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547215",
            "telephone_number": "907-631-4029",
            "fax_number": "907-631-4128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POORBAUGH",
        "first_name": "KEITH",
        "credential": "PT, SCD, OCS, FAAOMP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-27",
        "last_updated": "2022-07-21",
        "certification_date": "2022-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AK",
            "license": "1581",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob Pollard, DPT
• Erin Pollock
• Ashley Anne Polston
• Kayla Polston
• David George Poole
• Mikael Porcello
• Lindsey G Posey
• Positive Path LLC
• Joseph Potter IV
• Michelle Poulos

• Physical Therapist in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Physical Therapist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.