NPIMap

Organization Active NPI

Ptarmigan Pediatrics LLC

  • Pediatrics Physician
  • Wasilla, AK
National Provider Identifier
1053574293
Registry record updated Feb 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PTARMIGAN PEDIATRICS LLC
Practice address
3543 E Meridian Park Loop Ste a
Wasilla, AK 99654-7233
Phone
(907) 357-4543
Fax
(907) 357-4533
NPI assigned
Jul 8, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2025

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

Authorized official

Name
Dr. Laura J Peterson, MDNPI 1831188473
Title
Owner
Phone
(907) 357-4543

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X AK Primary

Addresses

Primary practice location

3543 E Meridian Park Loop Ste a
Wasilla, AK 99654-7233

Mailing address

3543 E Meridian Park Loop Ste a
Wasilla, AK 99654-7233
Phone (907) 357-4543

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
02D1086838Ptarmigan Pediatrics LLC3543 E Meridian Park LP, Suite a, Wasilla, AK 99654Certificate of waiverJul 20, 2028

National Provider Directory

National Provider Directory

Locations

3543 E Meridian Park Loop
Wasilla, AK 99654
Phone (907) 357-4543

3543 E Meridian Park Loop
Ste A
Wasilla, AK 99654
Phone (907) 357-4543

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1215475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739318400000",
    "number": "1053574293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3543 E MERIDIAN PARK LOOP STE A",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547233",
            "telephone_number": "907-357-4543",
            "fax_number": "907-357-4533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3543 E MERIDIAN PARK LOOP STE A",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547233",
            "telephone_number": "907-357-4543",
            "fax_number": "907-357-4533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PTARMIGAN PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-08",
        "last_updated": "2025-02-12",
        "certification_date": "2025-02-12",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-357-4543",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "AK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Feb 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.