NPIMap

Individual provider Active NPI

Joan C Itano Merrick, ANP

  • Nurse Practitioner
  • Kenai, AK
National Provider Identifier
1912075482
Registry record updated Mar 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
215 Issued in AK
Practice address
11472 Kenai Spur Hwy
Ste 2
Kenai, AK 99611-7756
Phone
(907) 283-6030
Fax
(907) 283-3194
NPI assigned
Dec 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 215 AK Primary

Addresses

Primary practice location

11472 Kenai Spur Hwy
Ste 2
Kenai, AK 99611-7756

Mailing address

11472 Kenai Spur Hwy
Ste 2
Kenai, AK 99611-7756
Phone (907) 283-6030

Other names 1

  • Joan C Itano Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK
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
I20050502000238 AK Practitioner - Nurse Practitioner 6901845791 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Redoubt Medical Group LLC.Group PAC ID 2961898366, 4 clinicians

Practice addresses (Care Compare)

130 S Willow St
Suite 1
Kenai, AK 99611-9107
Phone (907) 283-6030

Hospital & facility affiliations

  • Central Peninsula General Hospital Hospital, Soldotna, AK, CCN 020024

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
215AKMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Ideal Option, PLLC CurrentSince Apr 16, 2018 Accepting new patients
Redoubt Medical Group LLC. CurrentSince Feb 7, 2022 Accepting new patients
Kenneth S Hahn Past Accepting new patients

Locations

130 S Willow St
Ste 1
Kenai, AK 99611
Phone (907) 262-2596

416 Frontage Rd
#200
Kenai, AK 99611
Phone (907) 283-6030

416 Frontage Rd
#400
Kenai, AK 99611
Phone (907) 283-5487

Organizations & group practices 3

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 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646611200000",
    "number": "1912075482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11472 KENAI SPUR HWY",
            "address_2": "STE 2",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "996117756",
            "telephone_number": "907-283-6030",
            "fax_number": "907-283-3194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11472 KENAI SPUR HWY",
            "address_2": "STE 2",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "996117756",
            "telephone_number": "907-283-6030",
            "fax_number": "907-283-3194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ITANO MERRICK",
        "first_name": "JOAN",
        "middle_name": "C",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-01",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AK",
            "license": "215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOAN",
            "last_name": "ITANO",
            "middle_name": "C",
            "credential": "ANP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Kenai, AK

Sources for this page

Verify at the official NPI Registry.