Individual provider Active NPI

Donna Hasterok

  • Nurse Practitioner
  • Anchorage, AK
National Provider Identifier
1487193793
Registry record updated Aug 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209900 Issued in AK
Practice address
4015 Lake Otis Pkwy Ste 101
Anchorage, AK 99508-5235
Phone
(907) 375-5200
Fax
(907) 375-5203
NPI assigned
Feb 20, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RB090489 GA
Nurse Practitioner 363L00000X 209900 AK Primary

Addresses

Primary practice location

4015 Lake Otis Pkwy Ste 101
Anchorage, AK 99508-5235

Mailing address

4015 Lake Otis Pkwy Ste 101
Anchorage, AK 99508-5235
Phone (907) 375-5200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180717002415 GA Practitioner - Nurse Practitioner 9739464959 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209900AKMDNurse Practitioner
RB090489GAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cobb Nephrology Hypertension Associates, PC CurrentSince Dec 13, 2017 Accepting new patients

Locations

3875 Austell Rd
Ste 101
Austell, GA 30106
Phone (770) 941-8100

4444 Austell Rd
Austell, GA 30106
Phone (678) 460-2700

4019 Johns Rd
#100
Dallas, GA 30132
Phone (678) 460-2700

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BCHBDA

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1487548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690848000000",
    "number": "1487193793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4015 LAKE OTIS PKWY STE 101",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085235",
            "telephone_number": "907-375-5200",
            "fax_number": "907-375-5203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4015 LAKE OTIS PKWY STE 101",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085235",
            "telephone_number": "907-375-5200",
            "fax_number": "907-375-5203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASTEROK",
        "first_name": "DONNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-20",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RB090489",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AK",
            "license": "209900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anchorage, AK

Sources for this page

Verify at the official NPI Registry.