NPIMap

Organization Active NPI

Anchorage Pediatric Group

  • Pediatrics Physician
  • Anchorage, AK
National Provider Identifier
1538192513
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
1744 Issued in AK
Legal business name
ANCHORAGE PEDIATRIC GROUP
Practice address
3340 Providence Dr
Ste 500
Anchorage, AK 99508-4616
Phone
(907) 562-2423
NPI assigned
Jul 10, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Charles Ryan, MDNPI 1205936077
Title
Senior Partner
Phone
(907) 562-2423

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
Pediatrics Physician 208000000X 1744 AK Primary

Addresses

Primary practice location

3340 Providence Dr
Ste 500
Anchorage, AK 99508-4616

Mailing address

3340 Providence Dr
Ste 500
Anchorage, AK 99508-4616
Phone (907) 562-2423

Other identifiers 5

IdentifierTypeStateIssuer
MD1744MedicaidAK
MD1116MedicaidAK
MD2694MedicaidAK
MD3158MedicaidAK
MD3035MedicaidAK

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
02D1024455Anchorage Pediatric Group, LLC3340 Providence Drive Suite 500, Anchorage, AK 99508Certificate of waiverApr 12, 2028

National Provider Directory

National Provider Directory

Locations

3340 Providence Dr
Ste 500
Anchorage, AK 99508
Phone (907) 317-0622

Practitioners & affiliated clinicians

Practitioners 11

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": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1538192513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 PROVIDENCE DR",
            "address_2": "STE 500",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084616",
            "telephone_number": "907-562-2423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3340 PROVIDENCE DR",
            "address_2": "STE 500",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084616",
            "telephone_number": "907-562-2423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANCHORAGE PEDIATRIC GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RYAN",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "SENIOR PARTNER",
        "authorized_official_telephone_number": "907-562-2423",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AK",
            "license": "1744",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD1744",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD1116",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD2694",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD3158",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD3035",
            "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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.