Glacier Family Medicine Clinic LLC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

202 Issued in AK

Legal business name

GLACIER FAMILY MEDICINE CLINIC LLC

Practice address

11724 Seward Hwy
Ste D
Seward, AK 99664-9714

Phone

(907) 224-8733

Fax

(907) 224-8734

NPI assigned

Apr 8, 2007

Last updated

Apr 13, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Brent Allen Ursel, PACNPI 1679637011

Title

Ceo Physician Assistant

Phone

(907) 224-8733

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AK

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 4

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.

• Brent Alan Ursel, PAC

  • Physician Assistant
  • Seward, AK
  • NPI 1679637011
  Medicare reassignment Authorized official
• John K Botson, M.D., RPH

  • Rheumatology Physician
  • Anchorage, AK
  • NPI 1881700334
  NPD (past)
• Kristina Marie Erhart, PAC

  • Physician Assistant
  • Anchorage, AK
  • NPI 1497819841
  NPD (past)
• Paul D Raymond, MD

  • Family Medicine Physician
  • Homer, AK
  • NPI 1912075920

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1175990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302652800000",
    "number": "1942323779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11724 SEWARD HWY",
            "address_2": "STE D",
            "city": "SEWARD",
            "state": "AK",
            "postal_code": "996649714",
            "telephone_number": "907-224-8733",
            "fax_number": "907-224-8734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11724 SEWARD HWY",
            "address_2": "STE D",
            "city": "SEWARD",
            "state": "AK",
            "postal_code": "996649714",
            "telephone_number": "907-224-8733",
            "fax_number": "907-224-8734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLACIER FAMILY MEDICINE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-08",
        "last_updated": "2011-04-13",
        "status": "A",
        "authorized_official_last_name": "URSEL",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "CEO PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "907-224-8733",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PAC"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD22813",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia W Friel, PTA
• Alexis Fuller
• Jeanne Galvano
• Harriett Jane Gennaro, LADC
• Sarah Heller Germain, NCTMB
• James Thomas Glanton, LCSW
• Golden Door LLC. (Alchemy Wellness Collective)
• Ramon Gonzalez Jr., LAC.
• Cynthia Maria Gott
• Andrew Graves

• Physician Assistant in Seward, AK
• Providers in Seward, AK by specialty
• Physician Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.