NPIMap

Organization Active NPI

Medical Group of Alaska

  • Pain Medicine Physician
  • Wasilla, AK
National Provider Identifier
1174882971
Registry record updated May 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
1070929 Issued in AK
Legal business name
MEDICAL GROUP OF ALASKA
Practice address
3190 E Merdian Park Loop
Suite 207
Wasilla, AK 99654
Phone
(907) 373-9460
Fax
(907) 373-9461
NPI assigned
May 14, 2012
Organization subpart
Yes
Parent organization
LYNX MEDICAL SERVICES ORGANIZATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 24, 2022

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

Authorized official

Name
Christine Henry-Musa
Title
Ceo
Phone
(907) 357-7710

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X 949810 AK
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X 1070929 AK Primary
Durable Medical Equipment & Medical Supplies 332B00000X 1070929 AK

Addresses

Primary practice location

3190 E Merdian Park Loop
Suite 207
Wasilla, AK 99654

Mailing address

3190 E Meridian Park Loop Ste 207
Wasilla, AK 99654-7422
Phone (907) 357-7710

Other identifiers 1

IdentifierTypeStateIssuer
1658871MedicaidAK

Other names 1

  • Algone International Pain Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120626000747 AK Part B Supplier - Clinic/Group Practice 3971768854 Receives reassigned benefits from 3 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wasilla, AK; Juneau, AK; Anchorage, AK
O20160907002184 AK Part B Supplier - Clinic/Group Practice 7416243076 Receives reassigned benefits from 26 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wasilla, AK

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Lynx Medical Srvcs Org

Locations

8800 Glacier Hwy
Ste 220
Juneau, AK 99801
Phone (907) 523-5003

3066 E Meridian Park Loop
Ste 3
Wasilla, AK 99654

3190 E Meridian Park Loop
Ste 207
Wasilla, AK 99654
Phone (907) 357-7710

3066 E Meridian Park Loop
Ste 1
Wasilla, AK 99654
Phone (907) 707-1671

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DACAAA

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1336953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653350400000",
    "number": "1174882971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3190 E MERIDIAN PARK LOOP STE 207",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547422",
            "telephone_number": "907-357-7710",
            "fax_number": "907-357-7720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3190 E MERDIAN PARK LOOP",
            "address_2": "SUITE 207",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "99654",
            "telephone_number": "907-373-9460",
            "fax_number": "907-373-9461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL GROUP OF ALASKA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LYNX MEDICAL SERVICES ORGANIZATION",
        "enumeration_date": "2012-05-14",
        "last_updated": "2022-05-24",
        "certification_date": "2022-05-24",
        "status": "A",
        "authorized_official_last_name": "HENRY-MUSA",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "907-357-7710"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "AK",
            "license": "949810",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "AK",
            "license": "1070929",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AK",
            "license": "1070929",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1658871",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Algone International Pain Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wasilla, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2022; 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.