Active NPI
Anthony Jimenez
- Assisted Living Facility
- Anchorage, AK
National Provider Identifier
1104360452
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility
- License
- 101179
- Practice address
- 8401 Berry Patch Dr
Anchorage, AK 99502-7265 - Phone
- (907) 222-1028
- Fax
- (907) 222-1028
- NPI assigned
- Dec 6, 2016
- Last updated
- Aug 24, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | 101179 | AK | Primary |
Addresses
Primary practice location
8401 Berry Patch Dr
Anchorage, AK 99502-7265
Mailing address
8401 Berry Patch Dr
Anchorage, AK 99502-7265
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6800582 | Other | AK | DRIVER LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101179 | AK | MD | Assisted Living Facility |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bethel Assisted Living Home | Assisted Living Facility | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Assisted Living Facility
- Anchorage, AK
- NPI 1245748581
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1480982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1503532800000",
"number": "1104360452",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8401 BERRY PATCH DR",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995027265"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8401 BERRY PATCH DR",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995027265",
"telephone_number": "907-222-1028",
"fax_number": "907-222-1028"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIMENEZ",
"first_name": "ANTHONY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-12-06",
"last_updated": "2017-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "AK",
"license": "101179",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVER LICENSE",
"identifier": "6800582",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anchorage, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.