Alaska Neurodiagnostic and Rehabilitation Medicine, Inc

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

2061 Issued in AK

Legal business name

ALASKA NEURODIAGNOSTIC AND REHABILITATION MEDICINE, INC

Practice address

4120 Laurel St Ste 206
Anchorage, AK 99508-5392

Phone

(907) 562-2600

Fax

(907) 562-2602

NPI assigned

Mar 26, 2007

Organization subpart

No

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

Authorized official

Name

Matthew Edward Moore

Title

Cfo/ Administrator

Phone

(907) 562-2600

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Alaska Rehabilitation Medicine, Inc. Former legal business name

Locations

Practitioners 2

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

• Clyde A Bullion, PAC

  • Physician Assistant
  • Anchorage, AK
  • NPI 1497816052
  NPD (past)
• Joella Beard, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Ft Carson, CO
  • NPI 1477680254
  NPD (past)

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551657600000",
    "number": "1285752857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4120 LAUREL ST STE 206",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085392",
            "telephone_number": "907-562-2600",
            "fax_number": "907-562-2602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4120 LAUREL ST STE 206",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085392",
            "telephone_number": "907-562-2600",
            "fax_number": "907-562-2602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALASKA NEURODIAGNOSTIC AND REHABILITATION MEDICINE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2019-03-04",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "CFO/ ADMINISTRATOR",
        "authorized_official_telephone_number": "907-562-2600"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "AK",
            "license": "AA2061",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "AK",
            "license": "2061",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD2061",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MDG145",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alaska Rehabilitation Medicine, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Alaska Rehabilitation Medicine, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Alaska Native Tribal Health Consortium
• Alaska Natural Health Solutions, Inc.
• Alaska Nephrologists LLC
• Alaska Neuro Associates, LLC
• Alaska Neuro/Therapy Center, LLC
• Alaska Neurodiagnostics Specialists LLC
• Alaska Neurology Center LLC
• Alaska Neuropsychology, LLC
• Alaska Neuroscience Associates,LLC
• Alaska OB-GYN Associates,LLC

• Physical Medicine & Rehabilitation Physician in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Physical Medicine & Rehabilitation Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2019; 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.