NPIMap

Organization Active NPI

Set Free Alaska, Inc.

  • Addiction Medicine (Preventive Medicine) Physician
  • Wasilla, AK
National Provider Identifier
1053188508
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Preventive Medicine) PhysicianTaxonomy code 2083A0300X
Legal business name
SET FREE ALASKA, INC.
Practice address
7010 E Bogard Rd BLDG 2
Wasilla, AK 99654-4711
Phone
(907) 373-4732
Fax
(907) 476-4749
NPI assigned
Dec 5, 2023
Organization subpart
Yes
Parent organization
SET FREE ALASKA, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

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

Authorized official

Name
Megan Lindley
Title
Compliance Director
Phone
(907) 206-6055

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LA0401X
Addiction Medicine (Preventive Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083A0300X Primary

Addresses

Primary practice location

7010 E Bogard Rd BLDG 2
Wasilla, AK 99654-4711

Mailing address

PO Box 876741
Wasilla, AK 99687-6741
Phone (907) 373-4732

Other identifiers 1

IdentifierTypeStateIssuer
1748088MedicaidAK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200827003677 AK Part B Supplier - Clinic/Group Practice 2668899204 Receives reassigned benefits from 2 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wasilla, AK; Palmer, AK; Homer, AK

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Set Free Alaska Inc8 organizations share this tax ID, including this one
Part of
Set Free Alaska Inc

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/setfreealaska/r4/

NPI Registry JSON

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

{
    "created_epoch": "1701734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1053188508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 876741",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996876741",
            "telephone_number": "907-373-4732",
            "fax_number": "907-746-4749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7010 E BOGARD RD BLDG 2",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996544711",
            "telephone_number": "907-373-4732",
            "fax_number": "907-476-4749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SET FREE ALASKA, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SET FREE ALASKA, INC.",
        "enumeration_date": "2023-12-05",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A",
        "authorized_official_last_name": "LINDLEY",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_title_or_position": "COMPLIANCE DIRECTOR",
        "authorized_official_telephone_number": "907-206-6055"
    },
    "taxonomies": [
        {
            "code": "207LA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1748088",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wasilla, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.