NPIMap

Organization Active NPI

Heirloom Wellness & Birth LLC

  • Family Medicine Physician
  • Palmer, AK
National Provider Identifier
1457659906
Registry record updated Nov 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
HEIRLOOM WELLNESS & BIRTH LLC
Practice address
2323 S Trunk Rd
Suite 6
Palmer, AK 99645
Phone
(907) 746-6644
Fax
(317) 667-1982
NPI assigned
Mar 8, 2011
Last updated
Nov 16, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2021

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

Authorized official

Name
Kirsten A Gerrish, CDMNPI 1275667800
Title
Owner/Manager
Phone
(907) 746-6644

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Birthing Clinic/Center 261QB0400X
Midwife 176B00000X
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

2323 S Trunk Rd
Suite 6
Palmer, AK 99645

Mailing address

2323 S Trunk Rd
Suite 6
Palmer, AK 99645
Phone (907) 746-6644

Other identifiers 2

IdentifierTypeStateIssuer
1657481MedicaidAK
1571890MedicaidAK

Other names 2

  • Heritage Health and Birth LLC Former legal business name
  • Heirloom Birth Center, LLC Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ashley@heirloomwellnessandbirth.kareodirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200228001111 AK Part B Supplier - Clinic/Group Practice 5496182602 Receives reassigned benefits from 2 practitioners
Practice locations: Palmer, AK

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
02D1011632Heirloom Wellness and Birth, LLC2323 S Trunk Rd, Palmer, AK 99645Certificate of waiverApr 15, 2027

National Provider Directory

National Provider Directory

Locations

2323 S Trunk Rd
Apt 6
Palmer, AK 99645
Phone (907) 746-6644

Interoperability endpoints

  • Direct secure messaging: ashley@heirloomwellnessandbirth.kareodirect.com

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1299542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637020800000",
    "number": "1457659906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2323 S TRUNK RD",
            "address_2": "SUITE 6",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "99645",
            "telephone_number": "907-746-6644",
            "fax_number": "317-667-1982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2323 S TRUNK RD",
            "address_2": "SUITE 6",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "99645",
            "telephone_number": "907-746-6644",
            "fax_number": "317-667-1982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEIRLOOM WELLNESS & BIRTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-08",
        "last_updated": "2021-11-16",
        "certification_date": "2021-11-16",
        "status": "A",
        "authorized_official_last_name": "GERRISH",
        "authorized_official_first_name": "KIRSTEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "907-746-6644",
        "authorized_official_credential": "CDM"
    },
    "taxonomies": [
        {
            "code": "261QB0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Birthing",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1657481",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1571890",
            "state": "AK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ashley@heirloomwellnessandbirth.kareodirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct inbox",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "HIE",
            "address_1": "2323 S Trunk Rd",
            "address_2": "Suite 6",
            "city": "Palmer",
            "state": "AK",
            "country_code": "US",
            "postal_code": "99645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Heritage Health and Birth LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Heritage Health and Birth LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Heirloom Birth Center, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Palmer, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2021; 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.