Jonathan Dawson Hedges
Individual provider Active NPI Pediatrics Physician · Anchorage, AK
NPI 1184001042 · NPPES record last updated Mar 21, 2024
Key facts
- NPI
- 1184001042
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 197005 (AK)
- Practice address
- 4501 Diplomacy Dr
Anchorage, AK 99508-5919 - Phone
- (907) 729-4955
- NPI assigned
- Apr 29, 2015
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 12
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220809000590 | TX | Practitioner - Pediatric Medicine | 1456631894 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 197005 | AK | MD | Pediatrics Physician |
| 10094291-1205 | UT | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southcentral Foundation | Current | Accepting new patients | |
| Southcentral Foundation | Current | Accepting new patients | |
| Southcentral Foundation | Current |
Accepting new patients | |
| Southcentral Foundation | Current | Accepting new patients | |
| Southcentral Foundation | Current | Accepting new patients | |
| Southcentral Foundation | Current | Accepting new patients | |
| Alaska Native Tribal Health Consortium | Current |
Accepting new patients | |
| Southcentral Foundation | Current | Accepting new patients | |
| Southcentral Foundation | Current | Accepting new patients | |
| Southcentral Foundation | Current | Accepting new patients | |
| Southcentral Foundation | Past | Accepting new patients | |
| Southcentral Foundation | Past | Accepting new patients |
Locations
7033 E Tudor Rd
Anchorage, AK 99507
Phone (907) 729-0000
4501 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-1000
4315 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-1729
4320 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-0000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 10094291-1205 | UT | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatrics Physician | 208000000X | 197005 | AK | Yes |
Addresses
Primary practice location
4501 Diplomacy Dr
Anchorage, AK 99508-5919
Mailing address
4501 Diplomacy Dr
Anchorage, AK 99508-5919
Phone (907) 729-4955
Other practice location 1
100 N Mario Capecchi Dr
Salt Lake City, UT 84113
Phone (801) 662-1000
Other providers in Anchorage, AK
- Leland Hebert
- Darlene Heckler
- Colton Heckmann
- Joshua D Hedberg
- Elaine Marie Hedden
- Chaz Malik Hedgspeth
- Kristina Hedum
- Catherine Hefley
- Jessie N. Hegel
- Heather Heidorn
All providers in Anchorage, AK · Pediatrics 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 Mar 21, 2024. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.