NPIMap

Organization Active NPI

Medical Network of Alaska, LLC

Doing business as Capstone Diabetes and Endocrinology Center

  • Endocrinology, Diabetes & Metabolism Physician
  • Wasilla, AK
National Provider Identifier
1831763911
Registry record updated Aug 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
Legal business name
MEDICAL NETWORK OF ALASKA, LLC
Doing business as
Capstone Diabetes and Endocrinology Center
Practice address
3331 E Meridian Park Loop
Wasilla, AK 99654-7294
Phone
(907) 357-9590
NPI assigned
May 13, 2021
Last updated
Aug 2, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDICAL NETWORK OF ALASKA, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 2, 2021

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

Authorized official

Name
Jacquelyn Renee Blomker
Title
Director of Revenue Cycle
Phone
(907) 357-9590

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X NU Primary

Addresses

Primary practice location

3331 E Meridian Park Loop
Wasilla, AK 99654-7294

Mailing address

3122 E Meridian Park Loop
Wasilla, AK 99654-7255
Phone (907) 357-9590

Other identifiers 1

IdentifierTypeStateIssuer
2131798OtherAKSTATE OF ALASKA BUSINESS LICENSE

Other names 1

  • Capstone Diabetes and Endocrinology Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK, CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070424000329 AK Part B Supplier - Clinic/Group Practice 3072618859 Receives reassigned benefits from 103 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Palmer, AK; Wasilla, AK; Kenai, AK; Eagle River, AK; Anchorage, AK
O20240328000826 CA Part B Supplier - Clinic/Group Practice 3072618859 Receives reassigned benefits from 1 practitioner
Practice locations: Carlsbad, CA

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 15

National Provider Directory

National Provider Directory
Part of
Capstone Family Medicine LLC

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1620864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627862400000",
    "number": "1831763911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3122 E MERIDIAN PARK LOOP",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547255",
            "telephone_number": "907-357-9590",
            "fax_number": "907-357-9593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3331 E MERIDIAN PARK LOOP",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547294",
            "telephone_number": "907-357-9590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL NETWORK OF ALASKA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDICAL NETWORK OF ALASKA, LLC",
        "enumeration_date": "2021-05-13",
        "last_updated": "2021-08-02",
        "certification_date": "2021-08-02",
        "status": "A",
        "authorized_official_last_name": "BLOMKER",
        "authorized_official_first_name": "JACQUELYN",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "907-357-9590"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF ALASKA BUSINESS LICENSE",
            "identifier": "2131798",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Capstone Diabetes and Endocrinology Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 2, 2021; 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.