Individual provider Active NPI

Julianne Minarik, R.D.

  • Registered Dietitian
  • Anchorage, AK
National Provider Identifier
1720172471
Registry record updated Dec 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
12 Issued in AK
Practice address
3340 Providence Dr
A351
Anchorage, AK 99508-4691
Phone
(907) 212-4824
Fax
(907) 212-4831
NPI assigned
Oct 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 12 AK Primary

Addresses

Primary practice location

3340 Providence Dr
A351
Anchorage, AK 99508-4691

Mailing address

PO Box 4105
Portland, OR 97208-4105
Phone (866) 907-1068

Other identifiers 1

IdentifierTypeStateIssuer
1004004MedicaidAK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151215002753 AK Practitioner - Registered Dietitian Or Nutrition Professional 5294036349 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12AKMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services- Washington CurrentSince Nov 4, 2015 Accepting new patients

Locations

3340 Providence Dr
Ste A351
Anchorage, AK 99508
Phone (907) 212-4800

3831 Piper St
Ste S220
Anchorage, AK 99508
Phone (907) 212-3420

920 Compassion Cir
Anchorage, AK 99504
Phone (907) 212-9200

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449187200000",
    "number": "1720172471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4105",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972084105",
            "telephone_number": "866-907-1068",
            "fax_number": "425-917-9141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3340 PROVIDENCE DR",
            "address_2": "A351",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084691",
            "telephone_number": "907-212-4824",
            "fax_number": "907-212-4831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINARIK",
        "first_name": "JULIANNE",
        "credential": "R.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2015-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "AK",
            "license": "12",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1004004",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anchorage, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2015; 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.