NPIMap

Organization Active NPI

Providence Health & Services-Washington

Doing business as Providence Medical Group Alaska

  • Community/Behavioral Health Agency
  • Anchorage, AK
National Provider Identifier
1841814795
Registry record updated Jul 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
PROVIDENCE HEALTH & SERVICES-WASHINGTON
Doing business as
Providence Medical Group Alaska
Practice address
3200 Providence Dr
Anchorage, AK 99508-4615
Phone
(907) 212-6002
Fax
(907) 212-8340
NPI assigned
Jun 5, 2020
Last updated
Jul 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2025

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

Authorized official

Name
Donald Wayne Anderson Jr.
Title
Assistant Secretary of Enrollments
Phone
(425) 358-9786

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X
Clinical Social Worker 1041C0700X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

3200 Providence Dr
Anchorage, AK 99508-4615

Mailing address

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

Other names 1

  • PROVIDENCE MEDICAL GROUP ALASKA Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091029000679 AK Part B Supplier - Clinic/Group Practice 1557408176 Receives reassigned benefits from 225 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Anchorage, AK; Eagle River, AK; Kodiak, AK; Seward, AK; Valdez, AK

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

1200 W Northern Lights Blvd
Ste A
Anchorage, AK 99503
Phone (907) 212-2090

3340 Providence Dr
#A565
Anchorage, AK 99508
Phone (907) 212-2321

12001 Business Blvd
Ste 3B
Eagle River, AK 99577

Practitioners & affiliated clinicians

Practitioners 93

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 93

NPI Registry JSON

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

{
    "created_epoch": "1591315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752105600000",
    "number": "1841814795",
    "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": "3200 PROVIDENCE DR",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084615",
            "telephone_number": "907-212-6002",
            "fax_number": "907-212-8340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES-WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-05",
        "last_updated": "2025-07-10",
        "certification_date": "2025-07-10",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE MEDICAL GROUP ALASKA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PROVIDENCE MEDICAL GROUP ALASKA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 10, 2025; 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.