NPIMap

Individual provider Active NPI

Jordan Manelick

  • Physician Assistant
  • Wasilla, AK
National Provider Identifier
1871903955
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1001 S Knik Goose Bay Rd
Wasilla, AK 99654-8083
Phone
(907) 631-7800
NPI assigned
Apr 29, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1001 S Knik Goose Bay Rd
Wasilla, AK 99654-8083

Mailing address

1001 Knik Goose Bay Rd
Wasilla, AK 99654
Phone (907) 631-7800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160210001371 TX Practitioner - Physician Assistant 1658675731 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southcentral FoundationGroup PAC ID 5496663627, 168 clinicians

Practice addresses (Care Compare)

1001 S Knik Goose Bay Rd
Wasilla, AK 99654-8083

3900 Ambassador Dr
Anchorage, AK 99508-5922
Phone (907) 563-2662

4315 Diplomacy Dr
Anchorage, AK 99508-5926
Phone (907) 563-2662

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.77 of 100Reported as group
Quality
76.11
Promoting interoperability
100
Improvement activities
40
Cost
79.79

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Southcentral Foundation Current Accepting new patients
Southcentral Foundation CurrentSince Oct 26, 2015 Accepting new patients
Alaska Native Tribal Health Consortium CurrentSince Oct 26, 2015 Accepting new patients
Southcentral Foundation CurrentSince Oct 26, 2015 Accepting new patients
Southcentral Foundation Current Accepting new patients
Southcentral Foundation Current Accepting new patients

Locations

225 Eagle St
Anchorage, AK 99501
Phone (907) 729-6550

4315 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-1729

1 Flight Line Rd
Port Alsworth, AK 99653
Phone (907) 781-2256

1001 S Knik Goose Bay Rd
Wasilla, AK 99654
Phone (907) 631-7800

Interoperability endpoints

  • Direct secure messaging: jmanelick@direct.scf.cc

Organizations & group practices 6

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.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1398729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1871903955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 KNIK GOOSE BAY RD",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "99654",
            "telephone_number": "907-631-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 S KNIK GOOSE BAY RD",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996548083",
            "telephone_number": "907-631-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANELICK",
        "first_name": "JORDAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-29",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wasilla, AK

Sources for this page

Verify at the official NPI Registry.