NPIMap

Individual provider Active NPI

Trevor Dale Munger, CPO

  • Orthotist
  • Wasilla, AK
National Provider Identifier
1962761973
Registry record updated May 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OrthotistTaxonomy code 222Z00000X
License
CPO01700 Issued in DE
Practice address
1700 E Bogard Rd Ste 104
Building B
Wasilla, AK 99654-6563
Phone
(907) 743-9991
Fax
(907) 743-9992
NPI assigned
May 10, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2012

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthotist 222Z00000X CPO01700 DE Primary
Pedorthist 224L00000X CPO01700 DE
Prosthetist 224P00000X CPO01700 DE

Addresses

Primary practice location

1700 E Bogard Rd Ste 104
Building B
Wasilla, AK 99654-6563

Mailing address

5701 Lake Otis Pkwy Ste 400
Anchorage, AK 99507-1778
Phone (907) 743-9991

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

LicenseStateTypeSpecialty
CPO01700DEMDProsthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Munger Prosthetics and Orthotics, Inc. Orthotist Past Accepting new patients
Munger Prosthetics and Orthotics, Inc. Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1336608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336608000000",
    "number": "1962761973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5701 LAKE OTIS PKWY STE 400",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995071778",
            "telephone_number": "907-743-9991",
            "fax_number": "907-743-9992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 E BOGARD RD STE 104",
            "address_2": "BUILDING B",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996546563",
            "telephone_number": "907-743-9991",
            "fax_number": "907-743-9992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUNGER",
        "first_name": "TREVOR",
        "middle_name": "DALE",
        "credential": "CPO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-10",
        "last_updated": "2012-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": "DE",
            "license": "CPO01700",
            "primary": true
        },
        {
            "code": "224L00000X",
            "taxonomy_group": "",
            "desc": "Pedorthist",
            "state": "DE",
            "license": "CPO01700",
            "primary": false
        },
        {
            "code": "224P00000X",
            "taxonomy_group": "",
            "desc": "Prosthetist",
            "state": "DE",
            "license": "CPO01700",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wasilla, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2012; 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.