NPIMap

Organization Active NPI

Anchorage Bariatrics, LLC

  • Surgery Physician
  • Anchorage, AK
National Provider Identifier
1174076822
Registry record updated Nov 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
1033013 Issued in AK
Legal business name
ANCHORAGE BARIATRICS, LLC
Practice address
3909 Arctic Blvd
Suite 101
Anchorage, AK 99503-5770
Phone
(907) 644-8446
Fax
(907) 644-8448
NPI assigned
Jul 29, 2016
Last updated
Nov 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2024

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

Authorized official

Name
Justin Clark, MDNPI 1215132410
Title
Physician
Phone
(907) 644-8446

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 1033013 AK Primary
Adult Mental Health Clinic/Center 261QM0850X NU
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU

Addresses

Primary practice location

3909 Arctic Blvd
Suite 101
Anchorage, AK 99503-5770

Mailing address

PO Box 75039
Chicago, IL 60675-5039
Phone (866) 776-8150

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160830001318 AK Part B Supplier - Clinic/Group Practice 0042505018 Receives reassigned benefits from 23 practitioners
Practice locations: Anchorage, AK

National Provider Directory

National Provider Directory

Locations

3909 Arctic Blvd
Ste 101
Anchorage, AK 99503
Phone (907) 272-1275

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1469750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730764800000",
    "number": "1174076822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 75039",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606755039",
            "telephone_number": "866-776-8150",
            "fax_number": "314-621-7276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3909 ARCTIC BLVD",
            "address_2": "SUITE 101",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995035770",
            "telephone_number": "907-644-8446",
            "fax_number": "907-644-8448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANCHORAGE BARIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-29",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "907-644-8446",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AK",
            "license": "1033013",
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Nov 5, 2024; 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.