NPIMap

Individual provider Active NPI

Anthony James Rotello

  • Medical Physician Assistant
  • Jber, AK
National Provider Identifier
1699037945
Registry record updated Apr 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
019047 Issued in NY
Practice address
673 MDG, 5955 Zeamer Avenue
Jber, AK 99506-2306
Phone
(907) 580-5556
NPI assigned
Jun 12, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2018

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X MA056083 PA
Medical Physician Assistant 363AM0700X OA003028 PA
Surgical Physician Assistant 363AS0400X 50.003694 OH
Medical Physician Assistant 363AM0700X 019047 NY Primary

Addresses

Primary practice location

673 MDG, 5955 Zeamer Avenue
Jber, AK 99506-2306

Mailing address

251 Salina Meadows Pkwy
Ste 100
Syracuse, NY 13212-4516
Phone (315) 464-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, TX, AK3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20160421000229 NY Practitioner - Physician Assistant 7810133535 Reassigns benefits to 1 organization
I20190718000832 TX Practitioner - Physician Assistant 7810133535 Reassigns benefits to 1 organization
I20231222002718 AK Practitioner - Physician Assistant 7810133535 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4315 Diplomacy Dr
Anchorage, AK 99508-5926
Phone (907) 563-2662

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.93 of 100Reported as group
Quality
70.1
Promoting interoperability
100
Improvement activities
40
Cost
83.01

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
019047NYMDMedical Physician Assistant
MA056083PAMDMedical Physician Assistant
OA003028PAMDMedical Physician Assistant
50.003694OHMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Alaska Native Tribal Health Consortium CurrentSince Jun 24, 2019 Accepting new patients

Locations

4315 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-1729

4000 Ambassador Dr
Anchorage, AK 99508
Phone (907) 729-1900

Interoperability endpoints

  • Direct secure messaging: ajrotello@direct.anthc.org

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.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1339459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524614400000",
    "number": "1699037945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 SALINA MEADOWS PKWY",
            "address_2": "STE 100",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132124516",
            "telephone_number": "315-464-2000",
            "fax_number": "315-464-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "673 MDG, 5955 ZEAMER AVENUE",
            "city": "JBER",
            "state": "AK",
            "postal_code": "995062306",
            "telephone_number": "907-580-5556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTELLO",
        "first_name": "ANTHONY",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-12",
        "last_updated": "2018-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA056083",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "OA003028",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OH",
            "license": "50.003694",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "019047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jber, AK

Sources for this page

Verify at the official NPI Registry.