Spine And Sports Injury Center, Llc is a medicare enrolled "Family Medicine" provider in Wasilla, Alaska. Their current practice location is
1001 E Bogard Rd, Wasilla, Alaska. You can reach out to their office (for appointments etc.) via phone at
(907) 376-2225.
Spine And Sports Injury Center, Llc is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. Spine And Sports Injury Center, Llc
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1053690677.
Healthcare Provider's Profile
| Full Name | Spine And Sports Injury Center, Llc |
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| Type | Facility |
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| Speciality | Family Medicine |
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| Location | 1001 E Bogard Rd, Wasilla, Alaska |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1053690677
- Provider Enumeration Date: 08/12/2011
- Last Update Date: 02/04/2025
Medicare PECOS Information:
- PECOS PAC ID: 8628242666
- Enrollment ID: O20201229001033
Medical Identifiers
Medical identifiers for Spine And Sports Injury Center, Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1053690677 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 111NS0005X | Chiropractor - Sports Physician | 435 (Alaska) | Secondary |
| 225100000X | Physical Therapist | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Spine And Sports Injury Center, Llc acts as a billing entity for following providers:
| Provider Name | Patricia G Johnson |
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| Provider Type | Practitioner - Family Practice |
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| Provider Identifiers | NPI Number: 1750441820
PECOS PAC ID: 2769478999
Enrollment ID: I20040428001145 |
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| Provider Name | Amanda Constance Weidman |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1356105951
PECOS PAC ID: 5496195315
Enrollment ID: I20240425002520 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Spine And Sports Injury Center, Llc is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Spine And Sports Injury Center, Llc
1001 E Bogard Rd,
Wasilla, AK 99654-7114
Ph: (907) 376-2225 | Spine And Sports Injury Center, Llc
1001 E Bogard Rd,
Wasilla, AK 99654-7114
Ph: (907) 376-2225 |
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