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ALPINE MEDICAL GROUP LLC
NPI 1114681608
Nurse Practitioner - Family in Fairbanks, AK

Active since October 29, 2021CLIA Certified · 2 labs
605 CHIEF THOMAS DR, FAIRBANKS, AK 99709(907) 455-4555(833) 941-2349 Get Directions Write a Review

NPPES record last updated: September 4, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Sep 4, 2025, Aug 31, 2022 (2 updates tracked since 2022).

About Alpine Medical Group Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ALPINE MEDICAL GROUP LLC (NPI 1114681608) is a healthcare organization registered as a family in Fairbanks, Alaska and active in the NPI registry since October 2021. The organization holds 2 active CLIA laboratory certificates, maintains a secondary practice location in Fairbanks, and lists Haley Evens, Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1114681608
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameALPINE MEDICAL GROUP LLC
Location Address605 CHIEF THOMAS DRFairbanks, AK 99709-4848
Mailing Address605 Chief Thomas DrFairbanks, AK 99709-4848 · (907) 455-4555 · Fax (833) 941-2349
Phone(907) 455-4555
Fax(833) 941-2349
Organization SubpartNo
Authorized OfficialHaley EvensAuthorized Official · (907) 455-4555
Enumeration DateOctober 29, 2021
Last NPPES UpdateSeptember 4, 20252 updates tracked since enumeration
NPPES CertifiedSeptember 4, 2025
✔ NPI 1114681608 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 5

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedPhysician AssistantTaxonomy 363A00000X
Also ListedNurse Practitioner · PediatricsTaxonomy 363LP0200X
Also ListedNurse Practitioner · Primary CareTaxonomy 363LP2300X
605 CHIEF THOMAS DR, Fairbanks, AK 99709
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Secondary Practice Location 1

Location 12054 30th AveFairbanks, AK 99701-7316 · Phone (907) 455-4555 · Fax (833) 941-2349

Group Practice 2

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP
Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc., Premera Blue Cross Blue Shield of Alaska.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 02D2271966

Alpine Medical Group · Fairbanks, AK
Active · expires Nov 10, 2026
CLIA Number02D2271966
Laboratory TypePhysician Office
Certificate Effective DateNovember 11, 2024
Certificate Expiration DateNovember 10, 2026
Laboratory DirectorHaley Evens
Laboratory Phone(907) 455-4555
Laboratory LocationAlpine Medical Group605 Chief Thomas Drive, Fairbanks, AK 99709
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 02D2310347

Alpine Medical Group · Fairbanks, AK
Active · expires Sep 1, 2026
CLIA Number02D2310347
Laboratory TypePhysician Office
Certificate Effective DateSeptember 2, 2024
Certificate Expiration DateSeptember 1, 2026
Laboratory DirectorHaley Evens
Laboratory Phone(907) 455-4555
Laboratory LocationAlpine Medical Group2054 30th Ave, Fairbanks, AK 99701
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ELLEN ELIZABETH MCEWEN RDN
Dietitian, Registered
605 CHIEF THOMAS DR
FAIRBANKS, AK 99709
Fairbanks North Star Borough (907) 615-8142

Frequently Asked Questions

What is ALPINE MEDICAL GROUP LLC's NPI number?

The NPI number assigned to this healthcare provider is 1114681608, enumerated as an "organization" on October 29, 2021.

Where is the provider located?

The provider is located at 605 CHIEF THOMAS DR FAIRBANKS, AK 99709 and the phone number is (907) 455-4555.

What is the provider's specialty?

Nurse Practitioner with taxonomy code 363LF0000X and a focus in Family.

What insurance does ALPINE MEDICAL GROUP LLC accept?

The provider might be accepting Accepts: Moda Health Plan, Inc. and Premera Blue Cross Blue. Please consult your insurance carrier or call the provider to verify.