Active NPI
John L Dally, DO
- Family Medicine Physician
- Anchorage, AK
National Provider Identifier
1679264154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 210838
- Practice address
- 1201 E 36TH Ave
Anchorage, AK 99508-4372 - Phone
- (907) 562-9229
- Fax
- (907) 562-1603
- NPI assigned
- May 16, 2023
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 210838 | AK | Primary |
Addresses
Primary practice location
1201 E 36TH Ave
Anchorage, AK 99508-4372
Mailing address
PO Box 4105
Portland, OR 97208-4105
Phone (866) 907-1068
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AK
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230707001110 | AK | Order and Referring Only - Family Practice | 6002275187 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687478400000",
"number": "1679264154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4105",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972084105",
"telephone_number": "866-907-1068",
"fax_number": "425-917-9141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 E 36TH AVE",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995084372",
"telephone_number": "907-562-9229",
"fax_number": "907-562-1603"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DALLY",
"first_name": "JOHN",
"middle_name": "L",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-16",
"last_updated": "2023-06-23",
"certification_date": "2023-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AK",
"license": "210838",
"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 Jun 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.