NPIMap

Organization Active NPI

Capstone Family Medicine LLC

  • Non-Pharmacy Dispensing Site
  • Wasilla, AK
National Provider Identifier
1487040309
Registry record updated Apr 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
CAPSTONE FAMILY MEDICINE LLC
Practice address
3122 E Meridian Park Loop
Wasilla, AK 99654-7294
Phone
(907) 357-9590
NPI assigned
Apr 7, 2015
Organization subpart
Yes
Parent organization
CAPSTONE FAMILY MEDICINE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 7, 2015

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

Authorized official

Name
Wade Erickson, MD
Title
MD
Phone
(907) 357-9590

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X Primary

Addresses

Primary practice location

3122 E Meridian Park Loop
Wasilla, AK 99654-7294

Mailing address

6501 City West Pkwy
Eden Prairie, MN 55344-3248
Phone (952) 653-2525

Other names 1

  • Wade Erickson MD Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070424000329 AK Part B Supplier - Clinic/Group Practice 3072618859 Receives reassigned benefits from 103 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Palmer, AK; Wasilla, AK; Kenai, AK; Eagle River, AK; Anchorage, AK

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 15

National Provider Directory

National Provider Directory
Part of
Capstone Family Medical

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1428364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428364800000",
    "number": "1487040309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6501 CITY WEST PKWY",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443248",
            "telephone_number": "952-653-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3122 E MERIDIAN PARK LOOP",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547294",
            "telephone_number": "907-357-9590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPSTONE FAMILY MEDICINE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAPSTONE FAMILY MEDICINE LLC",
        "enumeration_date": "2015-04-07",
        "last_updated": "2015-04-07",
        "status": "A",
        "authorized_official_last_name": "ERICKSON",
        "authorized_official_first_name": "WADE",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "907-357-9590",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wade Erickson MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wasilla, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2015; 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.