Eagle River Primary Care

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA448 Issued in AK

Legal business name

EAGLE RIVER PRIMARY CARE

Doing business as

Eagle River Primary Care, LLC

Practice address

11462 Business Blvd
Eagle River, AK 99577-7721

Phone

(907) 694-0770

Fax

(907) 694-1378

NPI assigned

Nov 5, 2007

Last updated

May 21, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer J Oxford, PA-C

Title

Registered Agent

Phone

(907) 694-0770

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Eagle River Primary Care, LLC Doing business as

Practitioners 1

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.

• Olga Iris Wasile, MD

  • Family Medicine Physician
  • Chugiak, AK
  • NPI 1306952569
  NPD (past)

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

{
    "created_epoch": "1194220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590019200000",
    "number": "1235319450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11462 BUSINESS BLVD",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995777721",
            "telephone_number": "907-694-0770",
            "fax_number": "907-694-1378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11462 BUSINESS BLVD",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995777721",
            "telephone_number": "907-694-0770",
            "fax_number": "907-694-1378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE RIVER PRIMARY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-05",
        "last_updated": "2020-05-21",
        "status": "A",
        "authorized_official_last_name": "OXFORD",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "REGISTERED AGENT",
        "authorized_official_telephone_number": "907-694-0770",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AK",
            "license": "PA448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD42453",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1326187055",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD57671",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1407920085",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL SSN",
            "identifier": "$$$$$$$$$",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eagle River Primary Care, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Eagle Summit Dental Group
• Claudia Cook Eaves, M.S.
• Carey Ecker, CDC I

• Medical Physician Assistant in Eagle River, AK
• Providers in Eagle River, AK by specialty
• Medical Physician Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.