Active NPI
Jennifer Ilene Degraffenried, LMT
- Massage Therapist
- Wasilla, AK
National Provider Identifier
1700391885
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 127543
- Practice address
- 436 N Main St
Wasilla, AK 99654-7018 - Phone
- (907) 376-8020
- NPI assigned
- Dec 11, 2017
- Last updated
- Dec 11, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 127543 | AK | Primary |
Addresses
Primary practice location
436 N Main St
Wasilla, AK 99654-7018
Mailing address
1788 E Neil Cir Apt 3
Wasilla, AK 99654-8241
Phone (907) 717-5652
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 127543 | AK | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Payne Clinics LLC | Single Specialty | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512950400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512950400000",
"number": "1700391885",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1788 E NEIL CIR APT 3",
"city": "WASILLA",
"state": "AK",
"postal_code": "996548241",
"telephone_number": "907-717-5652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "436 N MAIN ST",
"city": "WASILLA",
"state": "AK",
"postal_code": "996547018",
"telephone_number": "907-376-8020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEGRAFFENRIED",
"first_name": "JENNIFER",
"middle_name": "ILENE",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-12-11",
"last_updated": "2017-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "AK",
"license": "127543",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wasilla, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.