NPIMap

Individual provider Active NPI

Robert Allen Bodnar

  • Peer Specialist
  • Soldotna, AK
National Provider Identifier
1003461617
Registry record updated Jan 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Peer SpecialistTaxonomy code 175T00000X
Practice address
245 N Binkley St Ste 202
Soldotna, AK 99669-7500
Phone
(907) 714-4521
Fax
(907) 260-4063
NPI assigned
Aug 9, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 13, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Peer Specialist 175T00000X Primary

Addresses

Primary practice location

245 N Binkley St Ste 202
Soldotna, AK 99669-7500

Mailing address

245 N Binkley St Ste 202
Soldotna, AK 99669-7500
Phone (907) 714-4521

Other practice location 1

47480 Kristina Way
Kenai, AK 99611-5902
Phone (907) 714-4521

Other practice location 2

354 Tyee St
Soldotna, AK 99669-7657
Phone (907) 714-4521

Other practice location 3

362 Tyee St
Soldotna, AK 99669-7631
Phone (907) 714-4521

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rbodnar1394943@ak.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Alaska Addiction Rehabilitation Services Inc. Dba Nugen'S Ranch Substance Abuse Rehabilitation Facility CurrentSince Aug 18, 2019 Accepting new patients
Central Peninsula General Hospital Inc Past Accepting new patients
Central Peninsula General Hospital, Inc PastSince Dec 13, 2020 Accepting new patients
Central Peninsula General Hospital, Inc PastSince Oct 25, 2020 Accepting new patients
Central Peninsula General Hospital, Inc Past Accepting new patients
Central Peninsula General Hospital, Inc Past Accepting new patients

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610496000000",
    "number": "1003461617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 N BINKLEY ST STE 202",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996697500",
            "telephone_number": "907-714-4521",
            "fax_number": "907-260-4063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 N BINKLEY ST STE 202",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996697500",
            "telephone_number": "907-714-4521",
            "fax_number": "907-260-4063"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "47480 Kristina Way",
            "address_purpose": "LOCATION",
            "city": "Kenai",
            "state": "AK",
            "postal_code": "996115902",
            "country_code": "US",
            "telephone_number": "907-714-4521",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "354 Tyee St",
            "address_purpose": "LOCATION",
            "city": "Soldotna",
            "state": "AK",
            "postal_code": "996697657",
            "country_code": "US",
            "telephone_number": "907-714-4521",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "362 Tyee St",
            "address_purpose": "LOCATION",
            "city": "Soldotna",
            "state": "AK",
            "postal_code": "996697631",
            "country_code": "US",
            "telephone_number": "907-714-4521",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BODNAR",
        "first_name": "ROBERT",
        "middle_name": "ALLEN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-08-09",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rbodnar1394943@ak.providencedirect.org",
            "affiliation": "N",
            "endpointDescription": "direct message",
            "address_1": "245 N Binkley St Ste 202",
            "city": "Soldotna",
            "state": "AK",
            "country_code": "US",
            "postal_code": "996697500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Soldotna, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.