NPIMap

Organization Active NPI

Greatland Mental Health, LLC

  • Psychiatry Physician
  • Anchorage, AK
National Provider Identifier
1477743532
Registry record updated Jul 25, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
GREATLAND MENTAL HEALTH, LLC
Practice address
1407 W 31St Ave
Ste 201
Anchorage, AK 99503-3678
Phone
(907) 929-4009
Fax
(907) 929-4902
NPI assigned
Jul 25, 2007
Last updated
Jul 25, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2007

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

Authorized official

Name
Ms. Theresa M Ronco
Title
Billing Manager
Phone
(907) 632-7577

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Psychiatry Physician 2084P0800X Primary

Addresses

Primary practice location

1407 W 31St Ave
Ste 201
Anchorage, AK 99503-3678

Mailing address

PO Box 111810
Anchorage, AK 99511-1810
Phone (907) 929-4009

Other identifiers 1

IdentifierTypeStateIssuer
MH3538MedicaidAK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090610000615 AK Part B Supplier - Clinic/Group Practice 4385794437 Receives reassigned benefits from 16 practitioners
Practice locations: Anchorage, AK

National Provider Directory

National Provider Directory

Locations

1400 W Benson Blvd
Ste 315
Anchorage, AK 99503
Phone (907) 929-4009

1400 W Benson Blvd
Ste 525
Anchorage, AK 99503
Phone (907) 929-4009

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1185321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185321600000",
    "number": "1477743532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 111810",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995111810",
            "telephone_number": "907-929-4009",
            "fax_number": "907-929-4902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 W 31ST AVE",
            "address_2": "STE 201",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995033678",
            "telephone_number": "907-929-4009",
            "fax_number": "907-929-4902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATLAND MENTAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-25",
        "last_updated": "2007-07-25",
        "status": "A",
        "authorized_official_last_name": "RONCO",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "907-632-7577",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MH3538",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anchorage, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.