ALASKA FACIAL PLASTIC SURGERY & ENT – Otolaryngology/Facial Plastic Surgery Physician, NPI 1114548351
Otolaryngology/Facial Plastic Surgery Physician
Main info
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Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for ALASKA FACIAL PLASTIC SURGERY & ENT
3719 E MERIDIAN LOOP STE E
WASILLA, AK 996547273
Phone: (079) 671-6017
Fax: (907) 631-0766
Type: Mailing
PO BOX 75045
CHICAGO, IL 606755045
Phone: (907) 600-0030
Fax: (907) 206-7153
Type: Mailing
3340 Providence Dr # A363
Anchorage, AK 995084691
Phone: (907) 671-6017
Fax: (907) 313-6857
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2020-06-25
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Revalidation due soon
Earliest CMS due date is 2026-07-31 (51 days away).
Enrollment records
1
Earliest due date
2026-07-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20200625001695 | O | Clinic/Group Practice | AK | 2026-07-31 |
What to do next
- Confirm the due date on the CMS Revalidation Lookup Tool.
- Complete revalidation in PECOS before the published due date.
- If you have multiple enrollment records, revalidate each one on its own schedule.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 99654)
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