NPIMap

Individual provider Active NPI

Enos Cheruiyot Ngetich, RN, NP-C

  • Family Nurse Practitioner
  • Wasilla, AK
National Provider Identifier
1396019188
Registry record updated Mar 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
207668 Issued in AK
Practice address
1001 S Knik Goose Bay Rd
Wasilla, AK 99654-8083
Phone
(907) 631-7800
NPI assigned
Feb 27, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1-118645 AL
Family Nurse Practitioner 363LF0000X 207668 AK Primary

Addresses

Primary practice location

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

Mailing address

7033 E Tudor Rd
Anchorage, AK 99507-1262
Phone (907) 729-6799

Other practice location 1

4316 Ridgemont Cir
Birmingham, AL 35244-1253
Phone (205) 240-8289

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
I20250327002342 TX Practitioner - Nurse Practitioner 6800057001 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southcentral FoundationGroup PAC ID 5496663627, 168 clinicians

Practice addresses (Care Compare)

1001 S Knik Goose Bay Rd
Valley Native Pri
Wasilla, AK 99654-8083
Phone (907) 729-6342

Hospital & facility affiliations

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Alaska Native Tribal Health Consortium CurrentSince Mar 1, 2025 Accepting new patients
Southcentral Foundation Current Accepting new patients
Southcentral Foundation CurrentSince Mar 1, 2025 Accepting new patients
Southcentral Foundation CurrentSince Mar 1, 2025 Accepting new patients
Qofl Services LLC Nurse Practitioner Past Accepting new patients
Banyan Alaska, LLC Past Accepting new patients

Locations

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

4501 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-1000

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

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

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

Organizations & group practices 6

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": "1330300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741910400000",
    "number": "1396019188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7033 E TUDOR RD",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995071262",
            "telephone_number": "907-729-6799",
            "fax_number": "907-729-5180"
        },
        {
            "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": [
        {
            "address_1": "4316 Ridgemont Cir",
            "address_purpose": "LOCATION",
            "city": "Birmingham",
            "state": "AL",
            "postal_code": "352441253",
            "country_code": "US",
            "telephone_number": "205-240-8289",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NGETICH",
        "first_name": "ENOS",
        "middle_name": "CHERUIYOT",
        "credential": "RN, NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-02-27",
        "last_updated": "2025-03-14",
        "certification_date": "2025-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "1-118645",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AK",
            "license": "207668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wasilla, AK

Sources for this page

Verify at the official NPI Registry.