Organization Active NPI

Solstice Medicine & Wellness, LLC

  • Medical Specialty Clinic/Center
  • Fairbanks, AK
National Provider Identifier
1710347349
Registry record updated Apr 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
1032552 Issued in AK
Legal business name
SOLSTICE MEDICINE & WELLNESS, LLC
Practice address
475 Riverstone Way Ste 2
Fairbanks, AK 99709-2971
Phone
(907) 456-6334
Fax
(907) 456-6336
NPI assigned
Feb 24, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2024

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

Authorized official

Name
Gina Escobar, MDNPI 1962560268
Title
Owner
Phone
(907) 978-5733

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X 1032552 AK Primary
Medical Specialty Clinic/Center 261QM2500X

Addresses

Primary practice location

475 Riverstone Way Ste 2
Fairbanks, AK 99709-2971

Mailing address

3875 Geist Rd Ste E154
Fairbanks, AK 99709-3564
Phone (907) 456-6334

Other identifiers 1

IdentifierTypeStateIssuer
1011882MedicaidAK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160426001187 AK Part B Supplier - Clinic/Group Practice 8729387741 Receives reassigned benefits from 3 practitioners
Practice locations: Fairbanks, AK

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
02D2116900Solstice Medicine & Wellness475 Riverstone Way #2, Fairbanks, AK 99709Certificate of waiverAug 2, 2026

National Provider Directory

National Provider Directory

Locations

475 Riverstone Way
Fairbanks, AK 99709
Phone (907) 374-9920

3875 Geist Rd
Ste E154
Fairbanks, AK 99709

Practitioners & affiliated clinicians

Practitioners 8

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": "1456272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714089600000",
    "number": "1710347349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3875 GEIST RD STE E154",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997093564",
            "telephone_number": "907-456-6334",
            "fax_number": "907-456-6336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 RIVERSTONE WAY STE 2",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997092971",
            "telephone_number": "907-456-6334",
            "fax_number": "907-456-6336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOLSTICE MEDICINE & WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-24",
        "last_updated": "2024-04-26",
        "certification_date": "2024-04-26",
        "status": "A",
        "authorized_official_last_name": "ESCOBAR",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-978-5733",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "AK",
            "license": "1032552",
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1011882",
            "state": "AK"
        }
    ],
    "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 Apr 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.