NPIMap

Organization Active NPI

Fairbanks Ultrasound, LLC.

  • Radiology Clinic/Center
  • Fairbanks, AK
National Provider Identifier
1235455809
Registry record updated Dec 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
License
935916 Issued in AK
Legal business name
FAIRBANKS ULTRASOUND, LLC.
Practice address
3419 Airport Way Ste D
Fairbanks, AK 99709-4761
Phone
(907) 474-2002
Fax
(907) 474-1622
NPI assigned
Apr 7, 2010
Last updated
Dec 9, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2010

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

Authorized official

Name
Jeffrey Alan Zuckerman, MD
Title
Director
Phone
(907) 456-7767

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X 935916 AK Primary

Addresses

Primary practice location

3419 Airport Way Ste D
Fairbanks, AK 99709-4761

Mailing address

315 Illinois St
Fairbanks, AK 99701-2910
Phone (907) 456-7767

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170706001834 AK Part B Supplier - Clinic/Group Practice 3577745264 Receives reassigned benefits from 9 practitioners
Practice locations: Fairbanks, AK

National Provider Directory

National Provider Directory

Locations

3419 Airport Way
Ste D
Fairbanks, AK 99709
Phone (907) 374-4644

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1270598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291852800000",
    "number": "1235455809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 ILLINOIS ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997012910",
            "telephone_number": "907-456-7767",
            "fax_number": "907-456-8050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3419 AIRPORT WAY STE D",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997094761",
            "telephone_number": "907-474-2002",
            "fax_number": "907-474-1622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRBANKS ULTRASOUND, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-07",
        "last_updated": "2010-12-09",
        "status": "A",
        "authorized_official_last_name": "ZUCKERMAN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "907-456-7767",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "AK",
            "license": "935916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2010; 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.