NPIMap

Organization Active NPI

Pioneer Peak Orthopedics LLC

  • Orthopaedic Surgery Physician
  • Wasilla, AK
National Provider Identifier
1548639727
Registry record updated Oct 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
PIONEER PEAK ORTHOPEDICS LLC
Practice address
3765 E. Blue Lupine Dr. Suite D
Wasilla, AK 99654
Phone
(907) 707-1671
NPI assigned
Sep 17, 2015
Last updated
Oct 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2023

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

Authorized official

Name
Michael Montano, M.D.NPI 1912132614
Title
Physician and 1/3 Owner
Phone
(907) 707-1671

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
Orthopaedic Surgery Physician 207X00000X NU 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
1635143MedicaidAK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151103000217 AK Part B Supplier - Clinic/Group Practice 8921318080 Receives reassigned benefits from 14 practitioners
Practice locations: Wasilla, AK

National Provider Directory

National Provider Directory

Locations

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

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1442448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696464000000",
    "number": "1548639727",
    "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": {
        "organization_name": "PIONEER PEAK ORTHOPEDICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-17",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A",
        "authorized_official_last_name": "MONTANO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PHYSICIAN AND 1/3 OWNER",
        "authorized_official_telephone_number": "907-707-1671",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1635143",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Oct 5, 2023; 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.