Individual provider Active NPI

Sarah Koogle, B.A

  • Professional Counselor
  • Fairbanks, AK
National Provider Identifier
1679817621
Registry record updated Nov 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Practice address
3830 S Cushman St
Fairbanks, AK 99701-7530
Phone
(907) 452-1575
NPI assigned
Nov 15, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 15, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X Primary

Addresses

Primary practice location

3830 S Cushman St
Fairbanks, AK 99701-7530

Mailing address

3830 S Cushman St
Fairbanks, AK 99701-7530
Phone (907) 452-1575

Other identifiers 1

IdentifierTypeStateIssuer
MH0157MedicaidAK

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240513003710 AK Practitioner - Mental Health Counselor 9739520479 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor of Arts

Practice roles

OrganizationSpecialtyStatusNew patients
Anchorage Community Mental Health Services, Inc CurrentSince Apr 1, 2024 Accepting new patients
Anchorage Community Mental Health Services Inc. Current Accepting new patients
Anchorage Community Mental Health Services, Inc CurrentSince Apr 1, 2024 Accepting new patients

Locations

4045 Lake Otis Pkwy
Ste 101
Anchorage, AK 99508
Phone (907) 337-5650

4045 Lake Otis Pkwy
Ste 209
Anchorage, AK 99508
Phone (907) 561-5440

4020 Folker St
Anchorage, AK 99508
Phone (907) 561-0954

Organizations & group practices 3

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": "1352937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352937600000",
    "number": "1679817621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3830 S CUSHMAN ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997017530",
            "telephone_number": "907-452-1575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3830 S CUSHMAN ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997017530",
            "telephone_number": "907-452-1575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOOGLE",
        "first_name": "SARAH",
        "name_prefix": "Mrs.",
        "credential": "B.A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-11-15",
        "last_updated": "2012-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MH0157",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

Verify at the official NPI Registry.