Active NPI
Robert Allen Wood, PA-C
- Surgical Physician Assistant
- Fairbanks, AK
National Provider Identifier
1457329542
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 139988
- Practice address
- 1919 Lathrop St
Fairbanks, AK 99701-5937 - Phone
- (907) 459-3500
- NPI assigned
- Mar 14, 2006
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA10003794 | WA | |
| Medical Physician Assistant | 363AM0700X | 139988 | AK | |
| Surgical Physician Assistant | 363AS0400X | 139988 | AK | Primary |
Addresses
Primary practice location
1919 Lathrop St
Fairbanks, AK 99701-5937
Mailing address
PO Box 73720
Fairbanks, AK 99707-3720
Phone (509) 990-9640
Other practice location 1
1414 N Houk Rd
Suite 200
Spokane Valley, WA 99216-1097
Phone (509) 838-2531
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010017647 | Other | ID | REGENCE BLUE SHIELD OF ID |
| 970019578 | Other | WA | RR MEDICARE |
| 8929877 | Other | WA | CRIME VICTIMS |
| WO4266 | Other | WA | ASURIS NW HEALTH |
| 379109600 | Other | WA | OWCP |
| 003783300 | Medicaid | ID | |
| 149074 | Other | WA | DEPT OF LABOR & INDUSTRI |
| 15388 | Other | WA | GROUP HEALTH NW |
| 8387359 | Medicaid | WA | |
| KQ506 | Other | ID | BLUE CROSS OF IDAHO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AK
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA10003794 | WA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwest Orthopaedic Specialists PS | Past | Accepting new patients | |
| Rockwood Clinic PS | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Orthopaedic Surgery Physician
- Fairbanks, AK
- NPI 1760938021
-
- Orthopaedic Surgery Physician
- Spokane, WA
- NPI 1609845825
-
- Ambulatory Surgical Clinic/Center
- Spokane, WA
- NPI 1912252693
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1546214400000",
"number": "1457329542",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 73720",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997073720",
"telephone_number": "509-990-9640",
"fax_number": "907-459-3500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1919 LATHROP ST",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997015937",
"telephone_number": "907-459-3500"
}
],
"practiceLocations": [
{
"address_1": "1414 N Houk Rd",
"address_2": "SUITE 200",
"address_purpose": "LOCATION",
"city": "Spokane Valley",
"state": "WA",
"postal_code": "992161097",
"country_code": "US",
"telephone_number": "509-838-2531",
"fax_number": "509-755-6580",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WOOD",
"first_name": "ROBERT",
"middle_name": "ALLEN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-14",
"last_updated": "2018-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "PA10003794",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "AK",
"license": "139988",
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "AK",
"license": "139988",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD OF ID",
"identifier": "000010017647",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "970019578",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CRIME VICTIMS",
"identifier": "8929877",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASURIS NW HEALTH",
"identifier": "WO4266",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OWCP",
"identifier": "379109600",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003783300",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT OF LABOR & INDUSTRI",
"identifier": "149074",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP HEALTH NW",
"identifier": "15388",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8387359",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF IDAHO",
"identifier": "KQ506",
"state": "ID"
}
],
"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 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.