Alcan Medical Group LLC
Organization Active NPI Family Medicine Physician · Fairbanks, AK
NPI 1134739485 · NPPES record last updated Dec 2, 2021
Key facts
- NPI
- 1134739485
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- ALCAN MEDICAL GROUP LLC
- Practice address
- 751 Old Richardson Hwy Ste 203
Fairbanks, AK 99701-7805 - Phone
- (303) 472-6424
- NPI assigned
- Aug 2, 2020
- Organization subpart
- No
Authorized official
- Name
- Casey E Blood, NP
- Title
- Owner
- Phone
- (907) 328-0844
Practitioners 5
-
Casey Blood, FNP
-
Jorge A. Chavez, FNP
-
Joan M Digeorge, RN, FNP-BC
-
Ashley Carolyn Brouwer, MSN, WHNP-BC, ANP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200922000566 | AK | Part B Supplier - Clinic/Group Practice | 1658799770 |
Receives reassigned benefits from 4 practitioners Practice locations: Fairbanks, AK; Palmer, AK |
National Provider Directory
Locations
751 Old Richardson Hwy
Ste 203
Fairbanks, AK 99701
Phone (303) 472-6424
751 Old Richardson Hwy
Ste 101
Fairbanks, AK 99701
Phone (303) 472-6424
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obesity and Weight Management Nutrition Registered Dietitian |
133VN1201X | |||
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
751 Old Richardson Hwy Ste 203
Fairbanks, AK 99701-7805
Mailing address
751 Old Richardson Hwy Ste 101
Fairbanks, AK 99701-7802
Phone (907) 328-0844
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All providers in Fairbanks, AK · Family Medicine Physician in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.