NPIMap

Organization Active NPI

Willow, LLC

Doing business as Willow Medical and Wellness

  • Psychiatry Physician
  • Anchorage, AK
National Provider Identifier
1548420920
Registry record updated Jun 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
5089 Issued in AK
Legal business name
WILLOW, LLC
Doing business as
Willow Medical and Wellness
Practice address
920 E 72ND Ave
Anchorage, AK 99518-2810
Phone
(907) 632-7577
Fax
(907) 522-4557
NPI assigned
Jun 10, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2008

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

Authorized official

Name
Dr. Eilleen Ha, MD
Title
Owner
Phone
(907) 632-7577

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X 5089 AK Primary

Addresses

Primary practice location

920 E 72ND Ave
Anchorage, AK 99518-2810

Mailing address

1407 W 31St Ave
Suite 200
Anchorage, AK 99503-3678
Phone (907) 632-7577

Other names 1

  • Willow Medical and Wellness Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091209000278 AK Part B Supplier - Clinic/Group Practice 5395884035 Receives reassigned benefits from 4 practitioners
Practice locations: Anchorage, AK

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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": "1213056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213056000000",
    "number": "1548420920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 W 31ST AVE",
            "address_2": "SUITE 200",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995033678",
            "telephone_number": "907-632-7577",
            "fax_number": "907-522-4557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 E 72ND AVE",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995182810",
            "telephone_number": "907-632-7577",
            "fax_number": "907-522-4557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-10",
        "last_updated": "2008-06-10",
        "status": "A",
        "authorized_official_last_name": "HA",
        "authorized_official_first_name": "EILLEEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-632-7577",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AK",
            "license": "5089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Medical and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 10, 2008; 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.