NPIMap

Individual provider Active NPI

Amani Ayisha Jackson

  • Professional Counselor
  • Fairbanks, AK
National Provider Identifier
1639742158
Registry record updated May 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
222527 Issued in AK
Practice address
1825 Marika Rd
Fairbanks, AK 99709-5521
Phone
(907) 474-0890
NPI assigned
Jul 22, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 222527 AK Primary
Community Health Worker 172V00000X

Addresses

Primary practice location

1825 Marika Rd
Fairbanks, AK 99709-5521

Mailing address

6631 E 9TH Ave
Anchorage, AK 99504-1725
Phone (305) 994-4251

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241009001050 TX Practitioner - Mental Health Counselor 5092246421 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southeast Alaska Regional Health ConsortiumGroup PAC ID 1456265362, 373 clinicians

Practice addresses (Care Compare)

3051 Vintage Blvd
200 Searhc Behav HLTH
Juneau, AK 99801-2807
Phone (907) 364-4445

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Alaska Regional Health Consortium Current Accepting new patients
Southeast Alaska Regional Health Consortium CurrentSince Sep 25, 2024 Accepting new patients
Southeast Alaska Regional Health Consortium CurrentSince Sep 25, 2024 Accepting new patients

Locations

3100 Channel Dr
Ste 300
Juneau, AK 99801
Phone (907) 463-4000

3051 Vintage Blvd
Ste 200
Juneau, AK 99801
Phone (907) 364-4445

3051 Vintage Blvd
#200
Juneau, AK 99801

222 Tongass Dr
Sitka, AK 99835
Phone (907) 966-8423

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1626912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1639742158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6631 E 9TH AVE",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995041725",
            "telephone_number": "305-994-4251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 MARIKA RD",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997095521",
            "telephone_number": "907-474-0890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AMANI",
        "middle_name": "AYISHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-22",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AK",
            "license": "222527",
            "primary": true
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

Verify at the official NPI Registry.