| Providence Medical Group Alaska | |
|
3760 Piper St Suite 1108 Anchorage AK 99508-4683 | |
| (907) 212-6900 | |
| (907) 212-6936 |
| Full Name | Providence Medical Group Alaska |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3760 Piper St, Anchorage, Alaska |
| Authorized Official Name and Position | Donald W Anderson (ASSISTANT SECRETARY FOR ENROLLMENT) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Group Alaska Po Box 4105 Portland OR 97208-4105 Ph: (866) 907-1068 | Providence Medical Group Alaska 3760 Piper St Suite 1108 Anchorage AK 99508-4683 Ph: (907) 212-6900 |
| NPI Number | 1538254347 |
|---|---|
| Provider Enumeration Date | 10/04/2006 |
| Last Update Date | 11/03/2021 |
| Certification Date | 11/03/2021 |
| Medicare PECOS PAC ID | 8628965910 |
|---|---|
| Medicare Enrollment ID | O20040302000372 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538254347 | NPI | - | NPPES |
| 1020510 | Medicaid | AK | |
| 1029396 | Medicaid | AK | |
| 1595841 | Medicaid | AK | |
| 1595851 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 282054 (Alaska) | Primary |
| Provider Name | Kahnaz Khari |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649291261 PECOS PAC ID: 2163456278 Enrollment ID: I20050919000692 |
| Provider Name | David E Telford |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750307450 PECOS PAC ID: 7719077353 Enrollment ID: I20071219000410 |
| Provider Name | Osamu H Matsutani |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134148828 PECOS PAC ID: 7315037959 Enrollment ID: I20071219000437 |
| Provider Name | Ellen J Halverson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467478164 PECOS PAC ID: 9931299575 Enrollment ID: I20071219000455 |
| Provider Name | Heather E Brock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992712442 PECOS PAC ID: 4183780505 Enrollment ID: I20090309000646 |
| Provider Name | Ronnie B Burns |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629027222 PECOS PAC ID: 0648293894 Enrollment ID: I20110818000830 |
| Provider Name | Nancy Magrath |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376685248 PECOS PAC ID: 4284806019 Enrollment ID: I20111020000183 |
| Provider Name | Erica Coady |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366759003 PECOS PAC ID: 3678769387 Enrollment ID: I20120118000648 |
| Provider Name | Nadine Demarco Baker |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1588822134 PECOS PAC ID: 2769616838 Enrollment ID: I20131002000546 |
| Provider Name | Sandra M Mitchell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235570979 PECOS PAC ID: 8123256161 Enrollment ID: I20140120000732 |
| Provider Name | Kelley Smart |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639419161 PECOS PAC ID: 4385934256 Enrollment ID: I20160606000506 |
| Provider Name | Kristin Rehmann |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447383997 PECOS PAC ID: 6002106770 Enrollment ID: I20160608001722 |
| Provider Name | Katherine Paulick |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679925325 PECOS PAC ID: 3779877881 Enrollment ID: I20160812001017 |
| Provider Name | Jane Larouche |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861794547 PECOS PAC ID: 1254651003 Enrollment ID: I20160817000695 |
| Provider Name | David Vernola |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316068695 PECOS PAC ID: 0547530156 Enrollment ID: I20170713003513 |
| Provider Name | Lisa Lindquist |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114278363 PECOS PAC ID: 7416172861 Enrollment ID: I20170817002496 |
| Provider Name | Tabatha Schellenger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104324177 PECOS PAC ID: 7911260054 Enrollment ID: I20180424001257 |
| Provider Name | Laura Crawford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588163794 PECOS PAC ID: 4688938210 Enrollment ID: I20180508001611 |
| Provider Name | Matthew Mark Huckabee |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477934636 PECOS PAC ID: 6507113503 Enrollment ID: I20191028002134 |
| Provider Name | Curt E Wengel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801276027 PECOS PAC ID: 3274838750 Enrollment ID: I20200818004170 |
| Provider Name | Renee Lamont |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295947034 PECOS PAC ID: 2961773957 Enrollment ID: I20201019003064 |
| Provider Name | Donna M Check |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427579234 PECOS PAC ID: 9830501410 Enrollment ID: I20201228000043 |
| Provider Name | Katherine Baum Corwin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336612068 PECOS PAC ID: 4082013032 Enrollment ID: I20210525002442 |
| Provider Name | Alia Rose Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316413206 PECOS PAC ID: 7911300314 Enrollment ID: I20210722002252 |
| Provider Name | William Alex Lehecka |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487883872 PECOS PAC ID: 5092118984 Enrollment ID: I20210729003289 |
| Provider Name | Angie Cronin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1164821229 PECOS PAC ID: 3375884273 Enrollment ID: I20220307001865 |
| Provider Name | Felicia Ankomah Kruh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356746234 PECOS PAC ID: 7113313164 Enrollment ID: I20220331001102 |
| Provider Name | Jonathan Eden Benaknin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992987655 PECOS PAC ID: 0143493106 Enrollment ID: I20230420001574 |
| Provider Name | Aurianna Santos |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417510512 PECOS PAC ID: 1355671371 Enrollment ID: I20230707003235 |
| Provider Name | Nelly Ayala |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336625771 PECOS PAC ID: 8123489481 Enrollment ID: I20230802003166 |
| Provider Name | Carolyn Claire Craig |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598225351 PECOS PAC ID: 4385973056 Enrollment ID: I20230824004034 |
| Provider Name | Savannah Rae Pascal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861174922 PECOS PAC ID: 7517320104 Enrollment ID: I20230830000931 |
| Provider Name | Rachael Hacke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063955482 PECOS PAC ID: 7012274145 Enrollment ID: I20230914003258 |
| Provider Name | Gavin Bryant |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831681337 PECOS PAC ID: 4082965280 Enrollment ID: I20231010004213 |
| Provider Name | Joclyn Diehl Reilly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720271885 PECOS PAC ID: 9436504974 Enrollment ID: I20231018002050 |
| Provider Name | Brandy Stratman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730347253 PECOS PAC ID: 9830546357 Enrollment ID: I20231106001025 |
| Provider Name | Alice D Baum |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720465867 PECOS PAC ID: 2163872466 Enrollment ID: I20231228003692 |
| Provider Name | Shana G. Hamilton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013239128 PECOS PAC ID: 5991155061 Enrollment ID: I20240102002647 |
| Provider Name | Wendy Sprague |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1407244486 PECOS PAC ID: 5496106320 Enrollment ID: I20240104003626 |
| Provider Name | Cheryl Ferucci |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609917434 PECOS PAC ID: 2062864044 Enrollment ID: I20240115001696 |
| Provider Name | Dannon O Mims |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699968693 PECOS PAC ID: 0749632909 Enrollment ID: I20240123004570 |
| Provider Name | Monique Y Andrews |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1164024485 PECOS PAC ID: 2163875329 Enrollment ID: I20240124003329 |
| Provider Name | Julie Elise Holden |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518300987 PECOS PAC ID: 8820441009 Enrollment ID: I20240124003924 |
| Provider Name | Rebecca Elizabeth Reed |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013113653 PECOS PAC ID: 1254784143 Enrollment ID: I20240126002414 |
| Provider Name | Sharon A. Fleck |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225227168 PECOS PAC ID: 0143673699 Enrollment ID: I20240131002902 |
| Provider Name | Anne L Cullings |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174007280 PECOS PAC ID: 7315390754 Enrollment ID: I20240201001165 |
| Provider Name | Tamara O Stadem |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1659306116 PECOS PAC ID: 2860835113 Enrollment ID: I20240203000541 |
| Provider Name | Marlin D Bozone |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548295009 PECOS PAC ID: 5799128476 Enrollment ID: I20240209001185 |
| Provider Name | Erica N Gonzalez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1033636071 PECOS PAC ID: 9335582857 Enrollment ID: I20240212001680 |
| Provider Name | Erin Marie Mclaughlin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851548820 PECOS PAC ID: 3072956531 Enrollment ID: I20240212003004 |
| Provider Name | Casey Granger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295517019 PECOS PAC ID: 8820432446 Enrollment ID: I20240221004341 |
Compass Counseling, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1236 G St, Anchorage, AK 99501 Phone: 907-317-7136 | |
Buckingham Psychological Services Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2401 E 42nd Ave Ste 306, Anchorage, AK 99508 Phone: 907-744-1882 | |
Jillanne Garrity Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 8721 Kathleen Dr, Anchorage, AK 99502 Phone: 907-312-4448 | |
Sealing Cove Counseling Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 821 N St Ste 102, Anchorage, AK 99501 Phone: 907-312-5564 | |
Frontier Health Services, P.c. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4241 B Street, Suite 305, Anchorage, AK 99503 Phone: 907-222-6688 Fax: 800-556-6916 | |
Building Blocks Academy Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3327 Fairbanks St, Anchorage, AK 99503 Phone: 907-331-8598 | |
Volunteers Of America Alaska, Russian Jack Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4300 E 20th Ave, Anchorage, AK 99508 Phone: 907-279-9640 |