Independence Park Medical Services Inc
Organization Active NPI Multi-Specialty Clinic/Center · Anchorage, AK
NPI 1366435273 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1366435273
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- Legal business name
- INDEPENDENCE PARK MEDICAL SERVICES INC
- Practice address
- 9500 Independence Dr
Ste 900
Anchorage, AK 99507-4615 - Phone
- (907) 522-1341
- Fax
- (907) 522-1343
- NPI assigned
- Aug 25, 2005
- Organization subpart
- No
Authorized official
- Name
- Ms. Helen R Spencer
- Title
- Clinic Manager
- Phone
- (907) 522-1342
Practitioners 11
-
Pebbles Dakota Shanley, M.D.
-
Jennifer Marie Davis, P.A.-C
-
Bradford W Fenton, M.D.
-
Leslie Ann Langum, PA-C
-
Kathryn Alexander Ryan, D.O.
-
Natasha Renae Sherrill, APRN
-
Therese D Ilalio, LPTA
-
Barbara Jo Pichon, RD LD
-
Dalton Maples Jr., PA-C
-
Heather E Patterson, DPT ATC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 02D0640552 | Independence Park Medical Services Inc | Compliance | Feb 25, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040105000130 | AK | Part B Supplier - Clinic/Group Practice | 9032018528 |
Receives reassigned benefits from 7 practitioners Practice locations: Anchorage, AK |
National Provider Directory
Locations
9500 Independence Dr
Ste 900
Anchorage, AK 99507
Phone (907) 522-1341
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/fdbc9673-c618-4425-b458-9d4512be1bb3/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | Yes |
Addresses
Primary practice location
9500 Independence Dr
Ste 900
Anchorage, AK 99507-4615
Mailing address
9500 Independence Dr
Ste 900
Anchorage, AK 99507-4615
Phone (907) 522-1341
Other providers in Anchorage, AK
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- Independence Lodge, LLC
- Independence Park Assisted Living
- Independent Care Coordination, LLC
- Independent Intelligence LLC
- Independent Life Transporation
- Naya Indira
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All providers in Anchorage, AK · Multi-Specialty Clinic/Center in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.