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COTTONWOOD CREEK CLINIC LLC
NPI 1134523855
Internal Medicine in Wasilla, AK

Active since October 09, 2014CLIA 02D2131541 · Waiver
3600 E WICKERSHAM WAY, WASILLA, AK 99654(907) 373-5950(907) 373-5954 Get Directions Write a Review

NPPES record last updated: March 7, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 7, 2023, Feb 14, 2020 (2 updates tracked since 2020).

About Cottonwood Creek Clinic Llc NPPES

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

COTTONWOOD CREEK CLINIC LLC (NPI 1134523855) is a healthcare organization registered as an internal medicine in Wasilla, Alaska and active in the NPI registry since October 2014. The organization holds a CLIA Waiver certificate valid through May 30, 2027 and lists Richard Blake, Owner, as its authorized official.

NPPES Registry Identity

NPI1134523855
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameCOTTONWOOD CREEK CLINIC LLC
Location Address3600 E WICKERSHAM WAYWasilla, AK 99654-7550
Mailing Address3600 E Wickersham WayWasilla, AK 99654-7550 · (907) 373-5950 · Fax (907) 373-5954
Phone(907) 373-5950
Fax(907) 373-5954
Organization SubpartNo
Authorized OfficialRichard BlakeOwner · (907) 373-5950
Enumeration DateOctober 9, 2014
Last NPPES UpdateMarch 7, 20232 updates tracked since enumeration
NPPES CertifiedFebruary 14, 2020
✔ NPI 1134523855 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in AK · 1011473
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
3600 E WICKERSHAM WAY, Wasilla, AK 99654
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Group Practice 1

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

Accepted Insurance

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

CLIA Laboratory Certificates CMS CLIA

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 02D2131541

Cottonwood Creek Clinic, LLC · Wasilla, AK
Active · expires May 30, 2027
CLIA Number02D2131541
Laboratory TypePhysician Office
Certificate Effective DateMay 31, 2025
Certificate Expiration DateMay 30, 2027
Laboratory DirectorRichard Blake
Laboratory Phone(907) 373-5650
Laboratory LocationCottonwood Creek Clinic, LLC3600 E Wickersham Way, Wasilla, AK 99654
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

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

MELISSA E SAN ROMAN
Hearing Instrument Specialist
3600 E WICKERSHAM WAY
WASILLA, AK 99654
Matanuska-Susitna Borough (907) 373-7700
RALEEN A MCCOURRY
Hearing Instrument Specialist
3600 E WICKERSHAM WAY
WASILLA, AK 99654
Matanuska-Susitna Borough (907) 373-7700
JAMES O STAENGEL
Hearing Instrument Specialist
3600 E WICKERSHAM WAY
WASILLA, AK 99654
Matanuska-Susitna Borough (907) 373-7700
RICHARD W. BLAKE PA-C
Physician Assistant (Medical)
3600 E WICKERSHAM WAY
WASILLA, AK 99654
Matanuska-Susitna Borough (907) 373-5950
OTTO INC
Hearing Instrument Specialist
3600 E WICKERSHAM WAY
WASILLA, AK 99654
Matanuska-Susitna Borough (907) 373-7700
JODIE H ESCOT
Hearing Instrument Specialist
3600 E WICKERSHAM WAY
WASILLA, AK 99654
Matanuska-Susitna Borough (907) 373-7700

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Cottonwood Creek Clinic LLC's NPI number?

The NPI number for Cottonwood Creek Clinic LLC is 1134523855. It was assigned to this organization in the NPPES registry on October 9, 2014.

Where is Cottonwood Creek Clinic LLC located?

Cottonwood Creek Clinic LLC is located at 3600 E Wickersham Way, Wasilla, AK 99654. The listed phone number is (907) 373-5950.

What is Cottonwood Creek Clinic LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Cottonwood Creek Clinic LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 02D2131541) is associated with this NPI, valid through May 30, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Cottonwood Creek Clinic LLC accept?

Health plans from Premera Blue Cross Blue Shield of Alaska list Cottonwood Creek Clinic LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Cottonwood Creek Clinic LLC was last updated on March 7, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.