| Mat-su Valley Iii Llc | |
|
2500 S Woodworth Loop Palmer AK 99645-8984 | |
| (907) 861-6565 | |
| (907) 861-6568 |
| Full Name | Mat-su Valley Iii Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2500 S Woodworth Loop, Palmer, Alaska |
| Authorized Official Name and Position | Kristy Music (DIRECTOR, PROVIDER ENROLLMENT) |
| Authorized Official Contact | 6154657377 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mat-su Valley Iii Llc Po Box 689022 Franklin TN 37068-9022 Ph: (615) 465-7042 | Mat-su Valley Iii Llc 2500 S Woodworth Loop Palmer AK 99645-8984 Ph: (907) 861-6565 |
| NPI Number | 1366752560 |
|---|---|
| Provider Enumeration Date | 10/21/2010 |
| Last Update Date | 12/12/2023 |
| Medicare PECOS PAC ID | 5496941502 |
|---|---|
| Medicare Enrollment ID | O20101130001385 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366752560 | NPI | - | NPPES |
| MPG0314 | Medicaid | AK |
| Provider Name | Paul D Forman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871606004 PECOS PAC ID: 5294729877 Enrollment ID: I20040527000333 |
| Provider Name | Shelis R Jorgensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164481107 PECOS PAC ID: 6800866807 Enrollment ID: I20040728000239 |
| Provider Name | Shawn A Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295878429 PECOS PAC ID: 4183725294 Enrollment ID: I20070719000340 |
| Provider Name | Michael Fitzgerald |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1831191527 PECOS PAC ID: 1759279508 Enrollment ID: I20111207000205 |
| Provider Name | Kirsten D Larson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104251990 PECOS PAC ID: 4981838356 Enrollment ID: I20131018000737 |
| Provider Name | Valerie Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033537568 PECOS PAC ID: 5991928665 Enrollment ID: I20140711000425 |
| Provider Name | Tamara J Little |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1760872766 PECOS PAC ID: 9739406919 Enrollment ID: I20150327000462 |
| Provider Name | Cassandra Cook |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1588961114 PECOS PAC ID: 3870807357 Enrollment ID: I20150728004357 |
| Provider Name | Rachel Adams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588990915 PECOS PAC ID: 4688935380 Enrollment ID: I20180220002363 |
| Provider Name | Michael A Dibartolo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316999808 PECOS PAC ID: 9931353109 Enrollment ID: I20180613000473 |
| Provider Name | Rachel Susan Cuevas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508878885 PECOS PAC ID: 5496713166 Enrollment ID: I20181005001916 |
| Provider Name | Violeta Diana Yeager |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518488204 PECOS PAC ID: 5395002414 Enrollment ID: I20190103002953 |
| Provider Name | Christy Dawn South |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1154478584 PECOS PAC ID: 7214021906 Enrollment ID: I20190917001293 |
| Provider Name | Zachary M Buck |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871023135 PECOS PAC ID: 3577832302 Enrollment ID: I20200625003258 |
| Provider Name | Umberto Gaetano Fontana |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1033111315 PECOS PAC ID: 0749326601 Enrollment ID: I20200715002721 |
| Provider Name | Rodney Badger |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1003874439 PECOS PAC ID: 2567418494 Enrollment ID: I20200721002230 |
| Provider Name | Joon Chang |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1720087257 PECOS PAC ID: 2264496330 Enrollment ID: I20200807002040 |
| Provider Name | Fahad Younas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447407465 PECOS PAC ID: 9436468964 Enrollment ID: I20200902000756 |
| Provider Name | Austin Bills |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336669092 PECOS PAC ID: 3274802012 Enrollment ID: I20201022000492 |
| Provider Name | Kenneth W Carr |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1245255439 PECOS PAC ID: 0143117655 Enrollment ID: I20201103002637 |
| Provider Name | Katrina L San Juan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770067985 PECOS PAC ID: 0648515502 Enrollment ID: I20210215000897 |
| Provider Name | Jasdeep Dalawari |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1215986807 PECOS PAC ID: 1759275167 Enrollment ID: I20210407002886 |
| Provider Name | Marcus Thiemann |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750876629 PECOS PAC ID: 5991054439 Enrollment ID: I20210903002677 |
| Provider Name | Jessica Lynn Bray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104590751 PECOS PAC ID: 4688072234 Enrollment ID: I20211012001511 |
| Provider Name | Rebekah A. Robinson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184777310 PECOS PAC ID: 4688717358 Enrollment ID: I20220523000269 |
| Provider Name | Srikanth Malladi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558848143 PECOS PAC ID: 6002284833 Enrollment ID: I20221128003064 |
| Provider Name | Divesh Anireddy |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1427094770 PECOS PAC ID: 4880586221 Enrollment ID: I20230126003100 |
| Provider Name | Seth Miller |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1891991717 PECOS PAC ID: 2668597667 Enrollment ID: I20230302002392 |
| Provider Name | Marti Marie Anliker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235843863 PECOS PAC ID: 2961876636 Enrollment ID: I20230320001819 |
| Provider Name | Shishira Bharadwaj |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1457587172 PECOS PAC ID: 7315102530 Enrollment ID: I20230323002114 |
| Provider Name | Haroon Yousaf |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1871731364 PECOS PAC ID: 2769514611 Enrollment ID: I20230328002507 |
| Provider Name | Suesue Scott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871208389 PECOS PAC ID: 2264897172 Enrollment ID: I20230428000692 |
| Provider Name | Amanda Killinger |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1932536687 PECOS PAC ID: 0345608931 Enrollment ID: I20230613003388 |
| Provider Name | Loyal Farley |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1659930006 PECOS PAC ID: 3375901002 Enrollment ID: I20230628000029 |
| Provider Name | Farhoud Khosravi |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1285874362 PECOS PAC ID: 3870761612 Enrollment ID: I20230705001721 |
| Provider Name | Jared R Beck |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1447678586 PECOS PAC ID: 7315205903 Enrollment ID: I20230912004342 |
| Provider Name | Tabitha Woods |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467132340 PECOS PAC ID: 4385099019 Enrollment ID: I20231016001413 |
| Provider Name | Amer Nassar |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1285016196 PECOS PAC ID: 4880909084 Enrollment ID: I20231017000690 |
| Provider Name | Jonathan Mellen |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1609919471 PECOS PAC ID: 3375715014 Enrollment ID: I20231212003467 |
| Provider Name | David Kovar |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1770536179 PECOS PAC ID: 9638151400 Enrollment ID: I20240223002732 |
| Provider Name | Fahim Jafary |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1083659700 PECOS PAC ID: 8820029259 Enrollment ID: I20240416003945 |
| Provider Name | Mikaela Maree Hull |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437901725 PECOS PAC ID: 0547600546 Enrollment ID: I20240424001455 |
The Family Health Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 561 S Denali St Ste E, Palmer, AK 99645 Phone: 907-745-1777 Fax: 907-745-0226 | |
Providence Matanuska Health Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2250 S. Woodworth Loop, Suite 101, Palmer, AK 99645 Phone: 907-761-5900 Fax: 907-761-5975 | |
Bruck Clift Md Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1901 North Hemmer Road Suite 110, Palmer, AK 99645 Phone: 907-746-6686 Fax: 907-745-7182 | |
Peninsula Pediatric Therapy, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7335 Palmer Wasilla Hwy, Palmer, AK 99645 Phone: 907-250-1151 Fax: 907-782-4202 | |
Ideal Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 440 W Evergreen Ave, Suite A, Palmer, AK 99645 Phone: 907-746-3366 | |
Family Life Matters, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 16720 E Maud Rd, Palmer, AK 99645 Phone: 907-631-3684 Fax: 907-707-1212 | |
Lakeview Family Practice, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1901 N Hemmer Rd Ste 211, Palmer, AK 99645 Phone: 907-203-4677 Fax: 907-745-3780 |