Organization Active NPI

David N Ampong

Doing business as Alaska Treatment Center

  • Psychiatric/Mental Health Nurse Practitioner
  • Anchorage, AK
National Provider Identifier
1104464460
Registry record updated May 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
DAVID N AMPONG
Doing business as
Alaska Treatment Center
Practice address
1577 C St Ste 201
Anchorage, AK 99501-5164
Phone
(907) 538-9958
Fax
(907) 865-2433
NPI assigned
Dec 18, 2019
Last updated
May 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2025

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

Authorized official

Name
Jennifer McDermott
Title
Credentialing Specialist
Phone
(505) 712-2662

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
Psychiatric/Mental Health Nurse Practitioner 363LP0808X Primary

Addresses

Primary practice location

1577 C St Ste 201
Anchorage, AK 99501-5164

Mailing address

1577 C St Ste 201
Anchorage, AK 99501-5164
Phone (907) 538-9958

Other identifiers 1

IdentifierTypeStateIssuer
1701389MedicaidAK

Other names 1

  • Alaska Treatment Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240528002220 AK Part B Supplier - Clinic/Group Practice 2365884913 Receives reassigned benefits from 3 practitioners
Practice locations: Anchorage, AK

National Provider Directory

National Provider Directory

Locations

130 W International Rd
Anchorage, AK 99518

1577 C St
Ste 204
Anchorage, AK 99501
Phone (907) 205-6912

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1576627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747699200000",
    "number": "1104464460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1577 C ST STE 201",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995015164",
            "telephone_number": "907-538-9958",
            "fax_number": "907-865-2433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1577 C ST STE 201",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995015164",
            "telephone_number": "907-538-9958",
            "fax_number": "907-865-2433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID N AMPONG",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-18",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-20",
        "status": "A",
        "authorized_official_last_name": "MCDERMOTT",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "505-712-2662"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1701389",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alaska Treatment Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Alaska Treatment Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 May 20, 2025; 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.