NPIMap

Organization Active NPI

Providence Anchorage Anesthesia Medical Group, P.C.

  • Anesthesiology Physician
  • Anchorage, AK
National Provider Identifier
1659368397
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
PROVIDENCE ANCHORAGE ANESTHESIA MEDICAL GROUP, P.C.
Practice address
3300 Providence Dr
Suite 207
Anchorage, AK 99508-4616
Phone
(907) 561-0005
Fax
(907) 563-9140
NPI assigned
Sep 27, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. James Brooks, CHE
Title
Chief Health Executive
Phone
(907) 561-0005

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

3300 Providence Dr
Suite 207
Anchorage, AK 99508-4616

Mailing address

3300 Providence Dr
Suite 207
Anchorage, AK 99508-4616
Phone (907) 561-0005

Other identifiers 2

IdentifierTypeStateIssuer
MDG394MedicaidAK
MDG395MedicaidAK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040401000952 AK Part B Supplier - Clinic/Group Practice 2163414830 Receives reassigned benefits from 86 practitioners
Practice locations: Anchorage, AK

National Provider Directory

National Provider Directory

Locations

3300 Providence Dr
Ste 207
Anchorage, AK 99508
Phone (907) 279-0555

Practitioners & affiliated clinicians

Practitioners 123

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 123

NPI Registry JSON

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

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1659368397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 PROVIDENCE DR",
            "address_2": "SUITE 207",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084616",
            "telephone_number": "907-561-0005",
            "fax_number": "907-563-9140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 PROVIDENCE DR",
            "address_2": "SUITE 207",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084616",
            "telephone_number": "907-561-0005",
            "fax_number": "907-563-9140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE ANCHORAGE ANESTHESIA MEDICAL GROUP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CHIEF HEALTH EXECUTIVE",
        "authorized_official_telephone_number": "907-561-0005",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CHE"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MDG394",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MDG395",
            "state": "AK"
        }
    ],
    "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 Aug 22, 2020; 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.