NPIMap

Organization Active NPI

Orthopedic & Sportsmedicine Clinic of Fairbanks LLC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Fairbanks, AK
National Provider Identifier
1689304982
Registry record updated Jun 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
Legal business name
ORTHOPEDIC & SPORTSMEDICINE CLINIC OF FAIRBANKS LLC
Practice address
2310 Peger Rd Ste 105
Fairbanks, AK 99709-5305
Phone
(907) 479-2663
Fax
(907) 479-2691
NPI assigned
Jun 10, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2022

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

Authorized official

Name
Dr. Neal Everson, DONPI 1295175651
Title
Member Manager
Phone
(907) 479-2663

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207XX0005X Primary

Addresses

Primary practice location

2310 Peger Rd Ste 105
Fairbanks, AK 99709-5305

Mailing address

2310 Peger Rd Ste 105
Fairbanks, AK 99709-5305
Phone (907) 479-2663

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220726002436 AK Part B Supplier - Clinic/Group Practice 8820470636 Receives reassigned benefits from 5 practitioners
Practice locations: Fairbanks, AK

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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": "1654819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654819200000",
    "number": "1689304982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2310 PEGER RD STE 105",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997095305",
            "telephone_number": "907-479-2663",
            "fax_number": "907-479-2691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 PEGER RD STE 105",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997095305",
            "telephone_number": "907-479-2663",
            "fax_number": "907-479-2691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDIC & SPORTSMEDICINE CLINIC OF FAIRBANKS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-10",
        "last_updated": "2022-06-10",
        "certification_date": "2022-06-10",
        "status": "A",
        "authorized_official_last_name": "EVERSON",
        "authorized_official_first_name": "NEAL",
        "authorized_official_title_or_position": "MEMBER MANAGER",
        "authorized_official_telephone_number": "907-479-2663",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2022; 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.