NPIMap

Individual provider Active NPI

Stephanie Rae McQuillin, APRN

  • Family Nurse Practitioner
  • Wasilla, AK
National Provider Identifier
1023503570
Registry record updated Nov 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
133098 Issued in AK
Practice address
1751 E Gardner Way Ste E
Wasilla, AK 99654-6564
Phone
(907) 376-9321
Fax
(907) 376-9322
NPI assigned
Jun 27, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 133098 AK Primary

Addresses

Primary practice location

1751 E Gardner Way Ste E
Wasilla, AK 99654-6564

Mailing address

1751 E Gardner Way Ste E
Wasilla, AK 99654-6564
Phone (907) 376-9321

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181211001917 AK Practitioner - Nurse Practitioner 6901140409 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dialysis Associates of Alaska, LLCGroup PAC ID 1456345123, 13 clinicians
Kidney and Hypertension Clinic of Alaska IncGroup PAC ID 0840299186, 14 clinicians

Practice addresses (Care Compare)

3260 Providence Dr
Suite C431
Anchorage, AK 99508-4661
Phone (907) 212-4840

4015 Lake Otis Pkwy
Suite 201
Anchorage, AK 99508-5235
Phone (907) 375-5200

Hospital & facility affiliations

  • Providence Alaska Medical Center Hospital, Anchorage, AK, CCN 020001
  • Mat-Su Regional Medical Center Hospital, Palmer, AK, CCN 020006
  • Fairbanks Memorial Hospital Hospital, Fairbanks, AK, CCN 020012
  • Central Peninsula General Hospital Hospital, Soldotna, AK, CCN 020024
  • Providence Kodiak Island Medical Ctr Hospital, Kodiak, AK, CCN 021306

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kidney and Hypertension Clinic of Alaska, Inc CurrentSince Dec 1, 2020 Accepting new patients
Dialysis Associates of Alaska, LLC CurrentSince Sep 26, 2023 Accepting new patients
Nephrology & Hypertension Associates of Alaska, PC PastSince Sep 26, 2023 Accepting new patients

Locations

3260 Providence Dr
Ste C431
Anchorage, AK 99508
Phone (907) 212-4840

4015 Lake Otis Pkwy
Ste 101
Anchorage, AK 99508

3260 Providence Dr
#326
Anchorage, AK 99508
Phone (907) 562-2712

4015 Lake Otis Pkwy
Ste 201
Anchorage, AK 99508
Phone (907) 771-3500

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22880/brand/1/csg/1/fhir/r4
  • Direct secure messaging: stephanie.mcquillin.1@22880.direct.athenahealth.com
  • Direct secure messaging: stephanie.mcquillin.1@14795.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 23

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1530057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573603200000",
    "number": "1023503570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1751 E GARDNER WAY STE E",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996546564",
            "telephone_number": "907-376-9321",
            "fax_number": "907-376-9322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1751 E GARDNER WAY STE E",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996546564",
            "telephone_number": "907-376-9321",
            "fax_number": "907-376-9322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCQUILLIN",
        "first_name": "STEPHANIE",
        "middle_name": "RAE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-27",
        "last_updated": "2019-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AK",
            "license": "133098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wasilla, AK

Sources for this page

Verify at the official NPI Registry.