Active NPI
Shannon Liat Irving
- Case Manager/Care Coordinator
- Bethel, AK
National Provider Identifier
1285909770
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 460 Ridgecrest Ave
Family Infant Toddler Program-Suite 214
Bethel, AK 99559-0281 - Phone
- (907) 543-1778
- Fax
- (907) 543-1276
- NPI assigned
- Mar 15, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
460 Ridgecrest Ave
Family Infant Toddler Program-Suite 214
Bethel, AK 99559-0281
Mailing address
PO Box 281
Bethel, AK 99559-0281
Phone (907) 545-5716
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1002573 | Medicaid | AK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1331769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386720000000",
"number": "1285909770",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 281",
"city": "BETHEL",
"state": "AK",
"postal_code": "995590281",
"telephone_number": "907-545-5716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "460 RIDGECREST AVE",
"address_2": "FAMILY INFANT TODDLER PROGRAM-SUITE 214",
"city": "BETHEL",
"state": "AK",
"postal_code": "995590281",
"telephone_number": "907-543-1778",
"fax_number": "907-543-1276"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IRVING",
"first_name": "SHANNON",
"middle_name": "LIAT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-03-15",
"last_updated": "2013-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1002573",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bethel, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.