MOOSE CREEK MEDICAL CLINIC LLC
NPI 1053883595
Nurse Practitioner - Adult Health in Wasilla, AK
NPI Status: Active since December 21, 2018
Contact Information
2341 S. FERN ST., SUITE 300
WASILLA, AK
ZIP 99654
Phone: (907) 373-3335
Fax: (907) 373-3331
- Organization
- Nurse Practitioner
- Adult Health
- Accepts Insurance
- CLIA Number: 02D2165694
- CLIA Cert. Type: Practitioner Other
- CLIA Exp. Date: 05-02-2027
About MOOSE CREEK MEDICAL CLINIC LLC
This page provides the complete NPI Profile along with additional information for Moose Creek Medical Clinic Llc, a provider established in Wasilla, Alaska operating as a Nurse Practitioner, focusing in adult health . The healthcare provider is registered in the NPI registry with number 1053883595 assigned on December 2018. The practitioner's primary taxonomy code is 363LA2200X. The provider is registered as an organization and their NPI record was last updated 7 years ago. Moose Creek Medical Clinic Llc operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Mrs. Kimberli Raye Brock Anp (Advanced Nurse Practitioner, Busine)
- NPI
- 1053883595
- Provider Name
- MOOSE CREEK MEDICAL CLINIC LLC
- Entity Type
- Organization
- Location Address
- 2341 S. FERN ST., SUITE 300 WASILLA, AK 99654
- Location Phone
- (907) 373-3335
- Location Fax
- (907) 373-3331
- Mailing Address
- 2341 S. FERN ST., SUITE 300 WASILLA, AK 99654
- Mailing Phone
- (907) 373-3335
- Mailing Fax
- (907) 373-3331
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 12-21-2018
- Last Update Date
- 12-21-2018
- Code Navigator
A nurse practitioner (NP) like Moose Creek Medical Clinic Llc is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Nurse Practitioner Adult Health
- Taxonomy Code
- 363LA2200X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
| 2 | 363LW0102X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Moda Select Alaska Bronze 6500 - PPO
- Moda Select Alaska Bronze HDHP 5500 - PPO
- Moda Select Alaska Gold 1500 - PPO
- Moda Select Alaska Silver 4500 - PPO
- Moda Select Alaska Standard Bronze - PPO
- Moda Select Alaska Standard Gold - PPO
- Moda Select Alaska Standard Silver - PPO
- Moda Select Texas Bronze 8700 ($0 Virtual Urgent Care through CirrusMD) - EPO
- Moda Select Texas Bronze HDHP 7500 - EPO
- Moda Select Texas Standard Bronze - EPO
- Moda Select Texas Standard Gold - EPO
- Moda Select Texas Standard Silver - EPO
- Premera Blue Cross Alaska One Gold - PPO
- Premera Blue Cross Preferred Bronze 5800 HSA - PPO
- Premera Blue Cross Preferred Bronze 6350 - PPO
- Premera Blue Cross Preferred Gold 1500 - PPO
- Premera Blue Cross Preferred Silver 4500 - PPO
- Premera Blue Cross Standard Bronze II - PPO
- Premera Blue Cross Standard Gold - PPO
- Premera Blue Cross Standard Silver - PPO
- Premera Blue Cross Family Dental - PPO
- Premera Blue Cross Pediatric Dental - PPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 1022256 | MEDICAID (05) | AK |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 02D2165694
- Facility Type
- Practitioner Other
- Certificate Effective Date
- May 03, 2025
- Certificate Expiration Date
- May 02, 2027
- Laboratory Director
- KYMBERLI R. BROCK
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to Moose Creek Medical Clinic Llc in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.
Reviews for MOOSE CREEK MEDICAL CLINIC LLC
There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.
NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1053883595, we treat the final digit (5) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 65. The final step is to find the difference between that total and the next multiple of ten (70 - 65 = 5).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 65 is 70. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1053883595, enumerated as an "organization" on December 21, 2018.
The provider is located at 2341 S. FERN ST., SUITE 300 WASILLA, AK 99654 and the phone number is (907) 373-3335.
Nurse Practitioner with taxonomy code 363LA2200X and a focus in Adult Health.
The provider might be accepting Accepts: Moda Health Plan, Inc., Premera Blue Cross Blue. Please consult your insurance carrier or call the provider to verify.
