Active NPI
Matthew Jeselnik
- Nursing Home Administrator
- Fairbanks, AK
National Provider Identifier
1386188720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nursing Home Administrator
- License
- 101139
- Practice address
- 1233 5TH Ave
Fairbanks, AK 99701-4211 - Phone
- (907) 317-1093
- NPI assigned
- Dec 4, 2016
- Last updated
- Dec 4, 2016
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Nursing Home Administrator | 376G00000X | 101139 | AK | Primary |
Addresses
Primary practice location
1233 5TH Ave
Fairbanks, AK 99701-4211
Mailing address
1233 5TH Ave
Fairbanks, AK 99701-4211
Phone (907) 317-1093
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101139 | AK | MD | Nursing Home Administrator |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifetothefullestllc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Assisted Living Facility (Mental Illness)
- Fairbanks, AK
- NPI 1245774108
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1480809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1480809600000",
"number": "1386188720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1233 5TH AVE",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997014211",
"telephone_number": "907-317-1093"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1233 5TH AVE",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997014211",
"telephone_number": "907-317-1093"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JESELNIK",
"first_name": "MATTHEW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-12-04",
"last_updated": "2016-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "376G00000X",
"taxonomy_group": "",
"desc": "Nursing Home Administrator",
"state": "AK",
"license": "101139",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.