NPIMap

Organization Active NPI

Medical Network of Alaska, LLC

  • Physical Therapist
  • Palmer, AK
National Provider Identifier
1669173647
Registry record updated Mar 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
MEDICAL NETWORK OF ALASKA, LLC
Practice address
1507 N Double B St
Palmer, AK 99645-5917
Phone
(907) 563-3145
Fax
(907) 561-3967
NPI assigned
Mar 15, 2023
Organization subpart
Yes
Parent organization
MEDICAL NETWORK OF ALASKA, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 15, 2023

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

Authorized official

Name
Jacquelyn Renee Blomker
Title
Director of Revenue Cycle
Phone
(907) 357-9590

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

1507 N Double B St
Palmer, AK 99645-5917

Mailing address

3122 E Meridian Park Loop
Wasilla, AK 99654-7255
Phone (907) 357-9590

Other names 1

  • Alaska Fracture and Orthopedic Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070424000329 AK Part B Supplier - Clinic/Group Practice 3072618859 Receives reassigned benefits from 103 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Palmer, AK; Wasilla, AK; Kenai, AK; Eagle River, AK; Anchorage, AK

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 15

National Provider Directory

National Provider Directory
Part of
Capstone Family Medical

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1678838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678838400000",
    "number": "1669173647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3122 E MERIDIAN PARK LOOP",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547255",
            "telephone_number": "907-357-9590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1507 N DOUBLE B ST",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996455917",
            "telephone_number": "907-563-3145",
            "fax_number": "907-561-3967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL NETWORK OF ALASKA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDICAL NETWORK OF ALASKA, LLC",
        "enumeration_date": "2023-03-15",
        "last_updated": "2023-03-15",
        "certification_date": "2023-03-15",
        "status": "A",
        "authorized_official_last_name": "BLOMKER",
        "authorized_official_first_name": "JACQUELYN",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "907-357-9590"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alaska Fracture and Orthopedic Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palmer, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 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.