Alaska Internal Medicine & Pediatrics LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

2342 Issued in AK

Legal business name

ALASKA INTERNAL MEDICINE & PEDIATRICS LLC

Practice address

4048 Laurel St Ste 306
Anchorage, AK 99508-5391

Phone

(907) 770-7800

Fax

(907) 929-4660

NPI assigned

Feb 2, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Michele L O'Fallon, M.D.NPI 1902877251

Title

Owner

Phone

(907) 770-7800

Specialties & licenses 2

Addresses

Other identifiers 4

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

• Michele O'Fallon, M.D.

  • Specialist
  • Anchorage, AK
  • NPI 1902877251

  AK, Specialist

  Medicare reassignment Care Compare group NPD Authorized official
• Summer Star Engler Jager, MD

  • Rheumatology Physician
  • Anchorage, AK
  • NPI 1871852319

  AK

  Medicare reassignment Care Compare group NPD
• Laurie Montano, M.D.

  • Specialist
  • Anchorage, AK
  • NPI 1710958061

  AK, Specialist

  Medicare reassignment Care Compare group NPD
• Rachael C Carricaburu, MD

  • Internal Medicine Physician
  • Anchorage, AK
  • NPI 1912181066
  Care Compare group
• Charles Michael Herndon, M.D.

  • Addiction Medicine (Internal Medicine) Physician
  • Anchorage, AK
  • NPI 1326062431
  NPD (past)
• Karin Marie Lien, LPC

  • Professional Counselor
  • Anchorage, AK
  • NPI 1023364478
  NPD (past)
• Amy Urbanus, RD

  • Registered Dietitian
  • Anchorage, AK
  • NPI 1184716250
  NPD (past)

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare fee-for-service enrollment

Enrolled in AK

Enrollment records 1

Locations

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214438400000",
    "number": "1366580912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4048 LAUREL ST STE 306",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085391",
            "telephone_number": "907-770-7800",
            "fax_number": "907-929-4660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4048 LAUREL ST STE 306",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085391",
            "telephone_number": "907-770-7800",
            "fax_number": "907-929-4660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALASKA INTERNAL MEDICINE & PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2008-06-26",
        "status": "A",
        "authorized_official_last_name": "O'FALLON",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-770-7800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "AK",
            "license": "AA3566",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "AK",
            "license": "2342",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "O'FALLON   (NPI)",
            "identifier": "1902877251",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD2282",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD7864",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MONTANO  (NPI)",
            "identifier": "1710958061",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alaska Innovative Medicine, Inc.
• Alaska Innovative Remodeling, Inc.
• Alaska Inpatient Neurology Services, LLC
• Alaska Integrative Medicine
• Alaska Integrative Psychiatry LLC
• Alaska Ips Medical Services LLC
• Alaska Kidney & Diabetes Association
• Alaska Kidney Consultants
• Alaska Love and Care Alh LLC
• Alaska Lung and Nodule Center LLC

• All providers in Anchorage, AK
• Specialist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.