Individual provider Active NPI

Mishelle Nace, M.D.

  • Pediatrics Physician
  • Fairbanks, AK
National Provider Identifier
1306811559
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
3836 Issued in AK
Practice address
1001 Noble St
Fairbanks, AK 99701-4922
Phone
(907) 459-3520
Fax
(907) 459-3554
NPI assigned
Feb 21, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 3836 AK Primary

Addresses

Primary practice location

1001 Noble St
Fairbanks, AK 99701-4922

Mailing address

1001 Noble St
Fairbanks, AK 99701-4922
Phone (907) 459-3500

Other identifiers 1

IdentifierTypeStateIssuer
1012552MedicaidAK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050421000030 AK Practitioner - Pediatric Medicine 7517905490 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
3836AKMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tanana Valley Clinic LLC CurrentSince Jan 1, 2017 Accepting new patients
Tanana Valley Clinic LLC CurrentSince Jan 1, 2017 Accepting new patients
Fairbanks Memorial Hospital, LLC Past Accepting new patients

Locations

1001 Noble St
Fairbanks, AK 99701
Phone (907) 276-2806

1650 Cowles St
Fairbanks, AK 99701
Phone (907) 452-8181

Interoperability endpoints

  • Direct secure messaging: mishelle.nace@direct.tananavalley.nextgenshare.com
  • Direct secure messaging: mishelle.nace@foundationhealth.cernerdirect.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1306811559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 NOBLE ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014922",
            "telephone_number": "907-459-3500",
            "fax_number": "907-459-3554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 NOBLE ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014922",
            "telephone_number": "907-459-3520",
            "fax_number": "907-459-3554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NACE",
        "first_name": "MISHELLE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-21",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AK",
            "license": "3836",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1012552",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

Verify at the official NPI Registry.