NPIMap

Organization Active NPI

Neuroversion

  • Interventional Pain Medicine Physician
  • Anchorage, AK
National Provider Identifier
1487102208
Registry record updated Dec 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
MEDS6555 Issued in AK
Legal business name
NEUROVERSION
Practice address
2925 Debarr Rd
Suite 240
Anchorage, AK 99508-2959
Phone
(907) 339-4650
NPI assigned
Sep 21, 2016
Last updated
Dec 19, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2016

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

Authorized official

Name
Luke Liu, MDNPI 1942413349
Title
Owner
Phone
(818) 523-5372

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine Physician 208VP0014X MEDS6555 AK Primary

Addresses

Primary practice location

2925 Debarr Rd
Suite 240
Anchorage, AK 99508-2959

Mailing address

2925 Debarr Rd
Suite 240
Anchorage, AK 99508-2959
Phone (818) 523-5372

Other identifiers 1

IdentifierTypeStateIssuer
1654351MedicaidAK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161208000642 AK Part B Supplier - Clinic/Group Practice 7012297062 Receives reassigned benefits from 11 practitioners
Practice locations: Anchorage, 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
02D2119644Neuroversion Inc2925 Debarr Road, Suite 240, Anchorage, AK 99508Certificate of waiverSep 29, 2026

National Provider Directory

National Provider Directory

Locations

2925 Debarr Rd
Ste 240
Anchorage, AK 99508
Phone (907) 290-1683

2925 Debarr Rd
Ste D240
Anchorage, AK 99508
Phone (907) 290-1683

Practitioners & affiliated clinicians

Practitioners 12

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": "1474416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482105600000",
    "number": "1487102208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 DEBARR RD",
            "address_2": "SUITE 240",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995082959",
            "telephone_number": "818-523-5372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2925 DEBARR RD",
            "address_2": "SUITE 240",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995082959",
            "telephone_number": "907-339-4650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROVERSION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-21",
        "last_updated": "2016-12-19",
        "status": "A",
        "authorized_official_last_name": "LIU",
        "authorized_official_first_name": "LUKE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-523-5372",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "AK",
            "license": "MEDS6555",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1654351",
            "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 Dec 19, 2016; 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.