NPI |
1679139596 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Employer Identification Number EIN |
|
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider Organization Name Legal Business Name |
EMPOWER MEDICAL AND WELLNESS |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider First Line Business Practice Location Address |
1901 N HEMMER RD STE 211 |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address City Name |
PALMER |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
AK |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Postal Code |
996459690 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Business Practice Location Address Country Code If outside U S |
US |
The date that a record was last updated or changed. |
Provider Business Practice Location Address Telephone Number |
9073154042 |
The code designating the provider’s gender if the provider is a person. |
Provider Business Practice Location Address Fax Number |
9073131417 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
5/16/2019 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Last Update Date |
2/1/2021 |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Authorized Official Last Name |
BRINKE |
|
Authorized Official First Name |
TYFANAE |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Authorized Official Title or Position |
FAMILY NURSE PRACTITIONER |
|
Authorized Official Telephone Number |
9073154042 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
261QH0100X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
N |
|
Healthcare Provider Taxonomy Code 2 |
261QI0500X |
|
Healthcare Provider Primary Taxonomy Switch 2 |
N |
|
Healthcare Provider Taxonomy Code 3 |
261QP2300X |
|
Healthcare Provider Primary Taxonomy Switch 3 |
Y |
|
Other Provider Identifier 1 |
1652161 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Other Provider Identifier Type Code 1 |
05 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Other Provider Identifier State 1 |
AK |
|
Is Organization Subpart |
N |
|
Authorized Official Credential Text |
ANP |
|
NPI Certification Date |
10/27/2020 |
|