NPIMap

Individual provider Active NPI

Charles Justin Haggerty, M.D.

  • Orthopaedic Surgery Physician
  • Wasilla, AK
National Provider Identifier
1487847430
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
MEDS8124 Issued in AK
Practice address
3765 E. Blue Lupine Dr. Suite D
Wasilla, AK 99654
Phone
(907) 707-1671
NPI assigned
Aug 23, 2007
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X MEDS8124 AK Primary

Addresses

Primary practice location

3765 E. Blue Lupine Dr. Suite D
Wasilla, AK 99654

Mailing address

3765 E. Blue Lupine Dr. Suite D
Wasilla, AK 99654
Phone (907) 707-1671

Other identifiers 1

IdentifierTypeStateIssuer
1635987MedicaidAK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151123001536 AK Practitioner - Orthopedic Surgery 9335380120 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Loyola University of Chicago, Stritch School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians
Pioneer Peak Orthopedics LLCGroup PAC ID 8921318080, 12 clinicians

Practice addresses (Care Compare)

10928 Eagle River Rd
Eagle River, AK 99577-8078
Phone (907) 694-8085

3765 E Blue Lupine Dr
Suite D
Wasilla, AK 99654-8417
Phone (907) 707-1671

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)120
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MEDS8124AKMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pioneer Peak Orthopedics LLC Orthopaedic Surgery CurrentSince Sep 17, 2015 Accepting new patients
Valley Upright Imaging LLC CurrentSince Sep 1, 2023 Accepting new patients

Locations

2490 S Woodworth Loop
Ste 200
Palmer, AK 99645
Phone (907) 746-7747

3765 E Blue Lupine Dr
Ste D
Wasilla, AK 99654
Phone (907) 707-1671

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 20

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1187827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1487847430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3765 E. BLUE LUPINE DR. SUITE D",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "99654",
            "telephone_number": "907-707-1671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3765 E. BLUE LUPINE DR. SUITE D",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "99654",
            "telephone_number": "907-707-1671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGGERTY",
        "first_name": "CHARLES",
        "middle_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-23",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "AK",
            "license": "MEDS8124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1635987",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wasilla, AK

Sources for this page

Verify at the official NPI Registry.