NPIMap

Organization Active NPI

Atlas Medical Aco LLC

  • Clinic/Center
  • Wasilla, AK
National Provider Identifier
1629807086
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
ATLAS MEDICAL ACO LLC
Practice address
3831 E Blue Lupine Dr Ste C
Wasilla, AK 99654-8461
Phone
(907) 521-2368
NPI assigned
Aug 1, 2024
Last updated
Oct 17, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ATLAS MEDICAL ACO LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

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

Authorized official

Name
Gregory Chad Mangum
Title
Owner
Phone
(435) 514-5646

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

3831 E Blue Lupine Dr Ste C
Wasilla, AK 99654-8461

Mailing address

PO Box 4682
Logan, UT 84323-4682

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241218000012 AK Part B Supplier - Clinic/Group Practice 1456885227 Receives reassigned benefits from 7 practitioners
Practice locations: Wasilla, AK

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Atlas Medical Aco LLC

Locations

3831 E Blue Lupine Dr
Ste C
Wasilla, AK 99654
Phone (907) 215-4846

Practitioners & affiliated clinicians

Practitioners 8

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": "1722470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729123200000",
    "number": "1629807086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4682",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843234682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3831 E BLUE LUPINE DR STE C",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996548461",
            "telephone_number": "907-521-2368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLAS MEDICAL ACO LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ATLAS MEDICAL ACO LLC",
        "enumeration_date": "2024-08-01",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A",
        "authorized_official_last_name": "MANGUM",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "CHAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "435-514-5646"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 17, 2024; 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.