NPIMap

Organization Active NPI

Alpine Medical Group LLC

  • Family Nurse Practitioner
  • Fairbanks, AK
National Provider Identifier
1114681608
Registry record updated Sep 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
ALPINE MEDICAL GROUP LLC
Practice address
605 Chief Thomas Dr
Fairbanks, AK 99709-4848
Phone
(907) 455-4555
Fax
(833) 941-2349
NPI assigned
Oct 29, 2021
Last updated
Sep 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2025

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

Authorized official

Name
Haley Evens, NPNPI 1700404779
Title
Authorized Official
Phone
(907) 455-4555

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Family Nurse Practitioner 363LF0000X NU Primary
Pediatric Nurse Practitioner 363LP0200X NU
Primary Care Nurse Practitioner 363LP2300X NU
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

605 Chief Thomas Dr
Fairbanks, AK 99709-4848

Mailing address

605 Chief Thomas Dr
Fairbanks, AK 99709-4848
Phone (907) 455-4555

Other practice location 1

2054 30th Ave
Fairbanks, AK 99701-7316
Phone (907) 455-4555

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220923002293 AK Part B Supplier - Clinic/Group Practice 7113302373 Receives reassigned benefits from 11 practitioners
Practice locations: Fairbanks, AK

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
02D2271966Alpine Medical Group605 Chief Thomas Drive, Fairbanks, AK 99709Certificate of waiverNov 10, 2026
02D2310347Alpine Medical Group2054 30TH Ave, Fairbanks, AK 99701Certificate of waiverSep 1, 2026

National Provider Directory

National Provider Directory

Locations

2054 30th Ave
Fairbanks, AK 99701
Phone (907) 455-4555

605 Chief Thomas Dr
Fairbanks, AK 99709
Phone (907) 455-4555

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1635465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756944000000",
    "number": "1114681608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 CHIEF THOMAS DR",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997094848",
            "telephone_number": "907-455-4555",
            "fax_number": "833-941-2349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 CHIEF THOMAS DR",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997094848",
            "telephone_number": "907-455-4555",
            "fax_number": "833-941-2349"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2054 30th Ave",
            "address_purpose": "LOCATION",
            "city": "Fairbanks",
            "state": "AK",
            "postal_code": "997017316",
            "country_code": "US",
            "telephone_number": "907-455-4555",
            "fax_number": "833-941-2349",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ALPINE MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-29",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A",
        "authorized_official_last_name": "EVENS",
        "authorized_official_first_name": "HALEY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "907-455-4555",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.