Individual provider Active NPI

Joseph Delong

  • Physician Assistant
  • Fairbanks, AK
National Provider Identifier
1972128924
Registry record updated Feb 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
186204 Issued in AK
Practice address
1423 Peger Rd
Fairbanks, AK 99709-5169
Phone
(907) 371-1300
NPI assigned
Jun 15, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 186204 AK Primary

Addresses

Primary practice location

1423 Peger Rd
Fairbanks, AK 99709-5169

Mailing address

1423 Peger Rd
Fairbanks, AK 99709-5169
Phone (206) 707-2555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK
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

Enrollment IDStateProvider typePAC IDDetails
I20211027002994 AK Practitioner - Physician Assistant 8729476510 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1423 Peger Rd
Fairbanks, AK 99709-5169
Phone (907) 371-1300

4020 Folker St
Anchorage, AK 99508-5386
Phone (907) 563-1000

4120 Laurel St
Suite 200
Anchorage, AK 99508-5392
Phone (907) 563-1000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
186204AKMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Anchorage Community Mental Health Services, Inc CurrentSince Sep 28, 2021 Accepting new patients

Locations

4045 Lake Otis Pkwy
Ste 209
Anchorage, AK 99508
Phone (907) 561-5440

4020 Folker St
Anchorage, AK 99508
Phone (907) 561-0954

1423 Peger Rd
Fairbanks, AK 99709
Phone (907) 371-1300

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": "1592179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645488000000",
    "number": "1972128924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1423 PEGER RD",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997095169",
            "telephone_number": "206-707-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1423 PEGER RD",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997095169",
            "telephone_number": "907-371-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELONG",
        "first_name": "JOSEPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-15",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "186204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

Verify at the official NPI Registry.