NPIMap

Organization Active NPI

Grayling Medical Group LLC

Doing business as Kenai Spine

  • Orthopaedic Surgery of the Spine Physician
  • Soldotna, AK
National Provider Identifier
1497002968
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X
License
6826 Issued in AK
Legal business name
GRAYLING MEDICAL GROUP LLC
Doing business as
Kenai Spine
Practice address
240 Hospital Place
Suite 103
Soldotna, AK 99669
Phone
(907) 260-5455
Fax
(877) 200-7122
NPI assigned
Aug 14, 2012
Last updated
Nov 30, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

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

Authorized official

Name
Nicole M Erb, BSN,RN
Title
Practice Administrator
Phone
(907) 714-3117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery of the Spine Physician 207XS0117X 6826 AK Primary

Addresses

Primary practice location

240 Hospital Place
Suite 103
Soldotna, AK 99669

Mailing address

PO Box 2509
Soldotna, AK 99669
Phone (907) 260-5455

Other identifiers 2

IdentifierTypeStateIssuer
MD9678MedicaidAK
1580702MedicaidAK

Other names 1

  • Kenai Spine Doing business as

National Provider Directory

National Provider Directory

Locations

1917 Abbott Rd
Anchorage, AK 99507
Phone (907) 260-5455

100 Trading Bay Rd
Ste B
Kenai, AK 99611
Phone (904) 260-5455

240 Hospital Pl
Ste 103
Soldotna, AK 99669
Phone (907) 260-5455

Practitioners & affiliated clinicians

Practitioners 6

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": "1344902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638230400000",
    "number": "1497002968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2509",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "99669",
            "telephone_number": "907-260-5455",
            "fax_number": "877-200-7122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 HOSPITAL PLACE",
            "address_2": "SUITE 103",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "99669",
            "telephone_number": "907-260-5455",
            "fax_number": "877-200-7122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAYLING MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-14",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A",
        "authorized_official_last_name": "ERB",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "907-714-3117",
        "authorized_official_credential": "BSN,RN"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "AK",
            "license": "6826",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD9678",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1580702",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kenai Spine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Soldotna, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.