Active NPI
Jerry Fonseca
- Mental Health Counselor
- Anchorage, AK
National Provider Identifier
1568078830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 1709 Bragaw St
Anchorage, AK 99508-3436 - Phone
- (907) 562-5340
- NPI assigned
- Sep 21, 2020
- Last updated
- Sep 21, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
1709 Bragaw St
Anchorage, AK 99508-3436
Mailing address
4939 Folker St Unit a
Anchorage, AK 99507-1456
Phone (907) 440-3000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alaskan Amazing Grace Alh LLC | Mental Health | Current | Accepting new patients |
| Alaska Children's Services, Inc. | Past | Accepting new patients |
Locations
4939 Folker St
#A
Anchorage, AK 99507
Phone (907) 222-1725
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Mental Health Counselor
- Anchorage, AK
- NPI 1508616236
-
dba AK Child & Family
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Anchorage, AK
- NPI 1538281514
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600646400000",
"number": "1568078830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4939 FOLKER ST UNIT A",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995071456",
"telephone_number": "907-440-3000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1709 BRAGAW ST",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995083436",
"telephone_number": "907-562-5340"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONSECA",
"first_name": "JERRY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-21",
"last_updated": "2020-09-21",
"certification_date": "2020-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"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 Sep 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.