Mark Alan Nelson, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

119037 Issued in AK

Practice address

436 5TH Ave
Medical Services, Maniilaq Health Center
Kotzebue, AK 99752

Phone

(907) 442-7148

NPI assigned

Feb 6, 2017

Sex

Male

Sole proprietor

Yes

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

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: manelson@direct.nshcorp.org

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.

• Maniilaq Association

  • Rural Acute Care Hospital
  • Kotzebue, AK
  • NPI 1861698805

  TX

  Medicare reassignment
• Maniilaq Association

  • Critical Access Hospital
  • Kotzebue, AK
  • NPI 1316995210
  NPD

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

{
    "created_epoch": "1486339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486339200000",
    "number": "1962940304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7934 NATIVE DANCER TRL",
            "city": "EVERGREEN",
            "state": "CO",
            "postal_code": "804396470",
            "telephone_number": "720-987-7481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "436 5TH AVE",
            "address_2": "MEDICAL SERVICES, MANIILAQ HEALTH CENTER",
            "city": "KOTZEBUE",
            "state": "AK",
            "postal_code": "99752",
            "telephone_number": "907-442-7148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "MARK",
        "middle_name": "ALAN",
        "credential": "P.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-02-06",
        "last_updated": "2017-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "119037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chelsie Morris, COMMUNITY HEALTH AID
• Dinetta Morris, M.ED, LPC
• Hannah Moto
• Roberta Ruth Moto
• Ariana Nelson, CHA I
• Barbara Newlin, COMMUNITY HEALTH AID
• Ashley Evelyn Nies, LPC-S, CDC-1
• Florence Nolton
• Northwest Arctic Borough School District
• Northwest Arctic Borough School District

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.