Active NPI
James V Penfield
- General Practice Dentistry
- Eagle River, AK
National Provider Identifier
1891997185
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1137
- Practice address
- 12641 Old Glenn Hwy Suite 101
Eagle River, AK 99577 - Phone
- (907) 688-7874
- Fax
- (907) 688-7876
- NPI assigned
- May 31, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1137 | AK | Primary |
Addresses
Primary practice location
12641 Old Glenn Hwy Suite 101
Eagle River, AK 99577
Mailing address
PO Box 672514
Chugiak, AK 99567-2514
Phone (907) 688-7874
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DD5399 | Medicaid | AK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1137 | AK | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1188950400000",
"number": "1891997185",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 672514",
"city": "CHUGIAK",
"state": "AK",
"postal_code": "995672514",
"telephone_number": "907-688-7874",
"fax_number": "907-622-7876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12641 OLD GLENN HWY SUITE 101",
"city": "EAGLE RIVER",
"state": "AK",
"postal_code": "99577",
"telephone_number": "907-688-7874",
"fax_number": "907-688-7876"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENFIELD",
"first_name": "JAMES",
"middle_name": "V",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-31",
"last_updated": "2007-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AK",
"license": "1137",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "DD5399",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eagle River, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.