Michael Pomeroy, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

179 Issued in AK

Practice address

1405 Kellum St
Suite 101
Fairbanks, AK 99701-4189

Phone

(907) 374-4636

Fax

(907) 374-4853

NPI assigned

Feb 21, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1922073188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 KELLUM ST",
            "address_2": "SUITE 101",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014189",
            "telephone_number": "907-374-4636",
            "fax_number": "907-374-4853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 KELLUM ST",
            "address_2": "SUITE 101",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014189",
            "telephone_number": "907-374-4636",
            "fax_number": "907-374-4853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POMEROY",
        "first_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-21",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AK",
            "license": "179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pleiades Counseling Inc.
• Matthew Poggemiller, DPT
• Polar Wind Medical Center, Inc.
• McKenzie Polsak
• Douglas R Pomeroy, PH.D.
• Elaine Ponchione, ANP, RN, PSY. A.
• Charlene Rae Pool
• Colleen Porter, OTR/L
• Asia Pouncy
• Elec Powell

• Medical Physician Assistant in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Medical Physician Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.