NPIMap

Organization Active NPI

Nurses Diversified Systems, Inc

  • Psychiatry Physician
  • Fairbanks, AK
National Provider Identifier
1972873784
Registry record updated Aug 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
1249 Issued in AK
Legal business name
NURSES DIVERSIFIED SYSTEMS, INC
Practice address
815 2ND Ave Ste 122
Fairbanks, AK 99701-4469
Phone
(907) 374-0852
Fax
(907) 374-0854
NPI assigned
Jan 10, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2021

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

Authorized official

Name
Teresa A Lyons, ANPNPI 1043524218
Title
Director
Phone
(907) 750-8114

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 1249 AK Primary

Addresses

Primary practice location

815 2ND Ave Ste 122
Fairbanks, AK 99701-4469

Mailing address

PO Box 72376
Fairbanks, AK 99707-2376
Phone (907) 750-8114

Other practice location 1

130 Trading Bay Rd Ste 340
Kenai, AK 99611-9116
Phone (907) 374-0852

Other practice location 2

407 5th Ave
Fairbanks, AK 99701-4715
Phone (907) 750-8114

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK, WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120321000698 AK Part B Supplier - Clinic/Group Practice 7517127996 Receives reassigned benefits from 8 practitioners
Practice locations: Anchorage, AK; Fairbanks, AK; Kenai, AK
O20200605000357 WA Part B Supplier - Clinic/Group Practice 7517127996 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Seattle, WA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

800 E Dimond Blvd
Ste 3-520
Anchorage, AK 99515
Phone (907) 374-0852

815 2nd Ave
Ste 122
Fairbanks, AK 99701
Phone (907) 328-9664

407 5th Ave
Fairbanks, AK 99701
Phone (907) 750-8114

815 2nd Ave
Ste 204
Fairbanks, AK 99701
Phone (907) 750-8114

130 S Willow St
Ste 3
Kenai, AK 99611

130 Trading Bay Rd
Ste 340
Kenai, AK 99611
Phone (907) 374-0852

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1326153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629072000000",
    "number": "1972873784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 72376",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997072376",
            "telephone_number": "907-750-8114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 2ND AVE STE 122",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014469",
            "telephone_number": "907-374-0852",
            "fax_number": "907-374-0854"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "130 Trading Bay Rd Ste 340",
            "address_purpose": "LOCATION",
            "city": "Kenai",
            "state": "AK",
            "postal_code": "996119116",
            "country_code": "US",
            "telephone_number": "907-374-0852",
            "fax_number": "907-374-0854",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "407 5th Ave",
            "address_purpose": "LOCATION",
            "city": "Fairbanks",
            "state": "AK",
            "postal_code": "997014715",
            "country_code": "US",
            "telephone_number": "907-750-8114",
            "fax_number": "907-459-8201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NURSES DIVERSIFIED SYSTEMS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-10",
        "last_updated": "2021-08-16",
        "certification_date": "2021-08-16",
        "status": "A",
        "authorized_official_last_name": "LYONS",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "907-750-8114",
        "authorized_official_credential": "ANP"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AK",
            "license": "1249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.