NPIMap

Organization Active NPI

Medical Network of Alaska, LLC

  • Specialist
  • Wasilla, AK
National Provider Identifier
1508089046
Registry record updated Nov 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
4593 Issued in AK
Legal business name
MEDICAL NETWORK OF ALASKA, LLC
Practice address
3122 E Meridian Park Loop
Wasilla, AK 99654-7255
Phone
(907) 357-9590
Fax
(907) 357-9593
NPI assigned
Apr 11, 2007
Organization subpart
Yes
Parent organization
CAPSTONE FAMILY MEDICINE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 2, 2020

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

Authorized official

Name
Jacquelyn Renee Blomker
Title
RCM
Phone
(907) 864-4625

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 4593 AK Primary

Addresses

Primary practice location

3122 E Meridian Park Loop
Wasilla, AK 99654-7255

Mailing address

3122 E Meridian Park Loop
Wasilla, AK 99654-7255
Phone (907) 357-9590

Other identifiers 2

IdentifierTypeStateIssuer
1651007MedicaidAK
MG0651MedicaidAK

Other names 1

  • Capstone Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK2 enrollments

Enrollment records 2

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
O20160907002184 AK Part B Supplier - Clinic/Group Practice 7416243076 Receives reassigned benefits from 26 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wasilla, AK

Other NPIs on the same Medicare enrollment 18

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

View all 18

National Provider Directory

National Provider Directory
Part of
Capstone Family Medical

Locations

1100 E Dimond Blvd
Anchorage, AK 99515
Phone (907) 565-6000

17025 Snowmobile Ln
Ste 103
Eagle River, AK 99577

2490 S Woodworth Loop
Ste 100
Palmer, AK 99645
Phone (907) 715-2733

12130 E Maple Springs Way
Palmer, AK 99645
Phone (907) 376-8938

3765 E Blue Lupine Dr
Ste C
Wasilla, AK 99654
Phone (907) 357-9560

6250 S Main St Ste 101
Aurora, CO 80016

Practitioners & affiliated clinicians

Practitioners 33

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

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604275200000",
    "number": "1508089046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3122 E MERIDIAN PARK LOOP",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547255",
            "telephone_number": "907-357-9590",
            "fax_number": "907-357-9593"
        },
        {
            "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": "996547255",
            "telephone_number": "907-357-9590",
            "fax_number": "907-357-9593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL NETWORK OF ALASKA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAPSTONE FAMILY MEDICINE LLC",
        "enumeration_date": "2007-04-11",
        "last_updated": "2020-11-02",
        "certification_date": "2020-11-02",
        "status": "A",
        "authorized_official_last_name": "BLOMKER",
        "authorized_official_first_name": "JACQUELYN",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "RCM",
        "authorized_official_telephone_number": "907-864-4625"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "AK",
            "license": "4593",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1651007",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MG0651",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Capstone Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Capstone Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Nov 2, 2020; 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.