NPIMap

Individual provider Active NPI

John Michael Davis, PA-C

  • Physician Assistant
  • Wasilla, AK
National Provider Identifier
1346839149
Registry record updated Feb 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
170531 Issued in AK
Practice address
1001 S Knik Goose Bay Rd
Wasilla, AK 99654-8083
Phone
(907) 631-7800
NPI assigned
Jan 15, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 170531 AK Primary

Addresses

Primary practice location

1001 S Knik Goose Bay Rd
Wasilla, AK 99654-8083

Mailing address

1001 S Knik Goose Bay Rd
Wasilla, AK 99654-8083
Phone (907) 631-7800

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210608001472 TX Practitioner - Physician Assistant 4385044676 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southcentral FoundationGroup PAC ID 5496663627, 168 clinicians

Practice addresses (Care Compare)

1 Flight Line Rd
Port Alsworth, AK 99653-9801
Phone (907) 729-6799

1001 S Knik Goose Bay Rd
Wasilla, AK 99654-8083

26341 Eklutna Village Rd
Native Village of Eklutna
Chugiak, AK 99567-5148
Phone (907) 688-6031

Hospital & facility affiliations

  • Alaska Native Medical Center Hospital, Anchorage, AK, CCN 020026

Merit-based Incentive Payment System (MIPS)

Final score
91.77 of 100Reported as group
Quality
76.11
Promoting interoperability
100
Improvement activities
40
Cost
79.79

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Southcentral Foundation Current Accepting new patients
Southcentral Foundation Current Accepting new patients
Southcentral Foundation Current Accepting new patients
Alaska Native Tribal Health Consortium CurrentSince May 18, 2021 Accepting new patients
Southcentral Foundation Current Accepting new patients
Southcentral Foundation CurrentSince May 18, 2021 Accepting new patients
Southcentral Foundation CurrentSince May 18, 2021 Accepting new patients
Southcentral Foundation Current Accepting new patients
Southcentral Foundation Past Accepting new patients

Locations

755 A St
Anchorage, AK 99501
Phone (907) 272-1255

4330 Elmore Rd
Anchorage, AK 99508
Phone (907) 729-6690

4320 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-0000

400 W Benson Blvd
Anchorage, AK 99503
Phone (907) 729-4200

225 Eagle St
Anchorage, AK 99501
Phone (907) 729-6550

7033 E Tudor Rd
Anchorage, AK 99507
Phone (907) 729-0000

1021 E 3rd Ave
Anchorage, AK 99501
Phone (907) 729-6342

4315 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-1729

26341 Eklutna Village Rd
Chugiak, AK 99567
Phone (907) 688-6031

1 Flight Line Rd
Port Alsworth, AK 99653
Phone (907) 781-2256

1001 S Knik Goose Bay Rd
Wasilla, AK 99654
Phone (907) 631-7800

Organizations & group practices 10

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

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1610668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675728000000",
    "number": "1346839149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 S KNIK GOOSE BAY RD",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996548083",
            "telephone_number": "907-631-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 S KNIK GOOSE BAY RD",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996548083",
            "telephone_number": "907-631-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JOHN",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-15",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "170531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wasilla, AK

Sources for this page

Verify at the official NPI Registry.