Active NPI
Mat Su Valley Medical Center LLC
Doing business as Mat-Su Regional Medical Center
- Medicare Defined Swing Bed Hospital Unit
- Palmer, AK
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medicare Defined Swing Bed Hospital Unit
- License
- 296969
- Legal business name
- MAT SU VALLEY MEDICAL CENTER LLC
- Doing business as
- Mat-Su Regional Medical Center
- Practice address
- 2500 S Woodworth Loop
Palmer, AK 99645-8984 - Phone
- (907) 861-6000
- Fax
- (907) 861-6559
- NPI assigned
- Jul 24, 2006
- Last updated
- Apr 14, 2021
- Organization subpart
- Yes
- Parent organization
- MAT SU VALLEY MEDICAL CENTER LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Paula M Lalor
- Title
- Director/Delegated Official
- Phone
- (629) 215-3953
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 296969 | AK | Primary |
Addresses
Primary practice location
2500 S Woodworth Loop
Palmer, AK 99645-8984
Mailing address
PO Box 1687
Palmer, AK 99645-1687
Phone (907) 861-6000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HS47SB | Medicaid | AK |
Other names 1
- Mat-Su Regional Medical Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AK
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070913000174 | AK | Part A Provider - Hospital | 5698686475 | Practice locations: Palmer, AK |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1003838384. Details of each certification follow.
Hospital certification: CCN 02U006
- Legal name
- MAT SU VALLEY MEDICAL CENTER LLC
- Doing business as
- MAT SU REGIONAL MEDICAL CENTER
- Organization structure
- LLC
- Incorporated
- Mar 28, 2003 in AK
- Enrollment address
- 2500 S Woodworth Loop
Palmer, AK 99645-8984 - Hospital subgroups
- Swing-bed approved
Related certifications (CCN) 1
Facilities connected through Provider of Services related, parent or unit certification numbers.
-
dba Mat-Su Regional Medical Center
- General Acute Care Hospital
- Palmer, AK
- NPI 1417975061
Unit of hospital
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Mat-Su Regional Urgent Care
- Urgent Care Clinic/Center
- Wasilla, AK
- NPI 1912950148
5698686475
-
dba Mat-Su Regional Medical Center
- General Acute Care Hospital
- Palmer, AK
- NPI 1417975061
5698686475
National Provider Directory
National Provider Directory- Part of
- Mat Su Valley Med Ctr LLC
Ownership & related parties
All disclosed owners & managing parties 18
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Kevin J Hammons | Corporate Officer | Feb 27, 2012 | |
| Corporate Director | Jan 1, 2020 | ||
| Nathaniel K Summar | Corporate Director | Jul 14, 2017 | |
| Justin D Pitt | Corporate Officer | Mar 1, 2022 | |
| Corporate Director | Mar 1, 2022 | ||
| William Bradley Cash | Corporate Officer | Jun 11, 2018 | |
| Hma-Tri Holdings LLC | 5% Or Greater Indirect Ownership Interest | Dec 31, 2015 | 100% |
| Community Health Systems Inc | 5% Or Greater Indirect Ownership Interest | Dec 3, 2013 | 100% |
| David T Wallace | W-2 Managing Employee | Jun 1, 2017 | |
| Jason Kevin Johnson | Corporate Officer | Jan 6, 2020 | |
| Roman Gabriel Ottinger | Corporate Officer | Jan 6, 2020 | |
| Valley Hospital Association Inc | 5% Or Greater Direct Ownership Interest | Jan 1, 2018 | 35% |
| Palmer-Wasilla Health System, LLC | 5% Or Greater Direct Ownership Interest | Jan 2, 2018 | 65% |
| Triad Holdings V LLC | 5% Or Greater Indirect Ownership Interest | Dec 4, 2013 | 100% |
| Paula M Lalor | Corporate Director | Apr 1, 2017 | |
| Triad Healthcare LLC | 5% Or Greater Indirect Ownership Interest | Dec 31, 2015 | 100% |
| Tennyson Holdings LLC | 5% Or Greater Indirect Ownership Interest | Dec 3, 2013 | 100% |
| Edna S Buffington-Price | Corporate Director | Mar 1, 2022 | |
| Christopher G Cobb | Corporate Officer | Apr 26, 2013 | |
| CHS Community Health Systems Inc | 5% Or Greater Indirect Ownership Interest | Dec 3, 2013 | 100% |
Facilities with the same owner 120
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Mat-Su Regional Medical Center
- General Acute Care Hospital
- Palmer, AK
- NPI 1417975061
CHS Community Health Systems Inc, Community Health Systems Inc, Hma-Tri Holdings LLC, Palmer-Wasilla Health System, LLC, Tennyson Holdings LLC, Triad Healthcare LLC, Triad Holdings V LLC, Valley Hospital Association Inc
-
dba Grandview Medical Center
- General Acute Care Hospital
- Birmingham, AL
- NPI 1023061405
CHS Community Health Systems Inc, Community Health Systems Inc, Hma-Tri Holdings LLC, Tennyson Holdings LLC, Triad Healthcare LLC
-
dba Grandview Medical Center
- Psychiatric Hospital Unit
- Birmingham, AL
- NPI 1043263221
CHS Community Health Systems Inc, Community Health Systems Inc, Hma-Tri Holdings LLC, Tennyson Holdings LLC
-
dba Grandview Medical Center
- Rehabilitation Hospital Unit
- Birmingham, AL
- NPI 1720001019
CHS Community Health Systems Inc, Community Health Systems Inc, Hma-Tri Holdings LLC, Tennyson Holdings LLC, Triad Healthcare LLC
-
dba Bluffton Regional Medical Center
- Medicare Defined Swing Bed Hospital Unit
- Bluffton, IN
- NPI 1356839591
CHS Community Health Systems Inc, Community Health Systems Inc, Hma-Tri Holdings LLC, Tennyson Holdings LLC, Triad Healthcare LLC
-
dba Bluffton Regional Medical Center
- General Acute Care Hospital
- Bluffton, IN
- NPI 1376594366
CHS Community Health Systems Inc, Community Health Systems Inc, Hma-Tri Holdings LLC, Tennyson Holdings LLC, Triad Healthcare LLC
-
dba Merit Health Rankin
- General Acute Care Hospital
- Brandon, MS
- NPI 1205882669
CHS Community Health Systems Inc, Community Health Systems Inc, Hma-Tri Holdings LLC
-
dba Merit Health Rankin
- Psychiatric Hospital Unit
- Brandon, MS
- NPI 1427098391
CHS Community Health Systems Inc, Community Health Systems Inc, Hma-Tri Holdings LLC
-
dba Western Arizona Regional Medical Center
- General Acute Care Hospital
- Bullhead City, AZ
- NPI 1255302766
CHS Community Health Systems Inc, Community Health Systems Inc
-
- Skilled Nursing Facility
- La Follette, TN
- NPI 1023099447
CHS Community Health Systems Inc, Community Health Systems Inc, Hma-Tri Holdings LLC
-
dba Tennova Primary Care Caryville
- Rural Health Clinic/Center
- Caryville, TN
- NPI 1023613361
CHS Community Health Systems Inc, Community Health Systems Inc, Hma-Tri Holdings LLC
-
dba Tennova Primary Care Clinton
- Rural Health Clinic/Center
- Clinton, TN
- NPI 1093300717
CHS Community Health Systems Inc, Community Health Systems Inc, Hma-Tri Holdings LLC
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
dba Mat-Su Regional Medical Center
- General Acute Care Hospital
- Palmer, AK
- NPI 1417975061
Practitioners & affiliated clinicians
Practitioners 18
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Psychiatric/Mental Health Nurse Practitioner
- Palmer, AK
- NPI 1164829354
-
- Psychiatry Physician
- Palmer, AK
- NPI 1700382363
-
- Medical Physician Assistant
- Palmer, AK
- NPI 1205229341
-
- Emergency Medicine Physician
- Palmer, AK
- NPI 1306974191
-
- Psychiatric/Mental Health Nurse Practitioner
- Palmer, AK
- NPI 1689850190
-
- Emergency Medical Services (Emergency Medicine) Physician
- Anchorage, AK
- NPI 1659930006
-
- Family Nurse Practitioner
- Palmer, AK
- NPI 1013801877
-
- Family Nurse Practitioner
- Anchorage, AK
- NPI 1891344297
-
- Medical Physician Assistant
- Wasilla, AK
- NPI 1669552550
-
- Hospitalist Physician
- Palmer, AK
- NPI 1013938729
-
- Physician Assistant
- Wasilla, AK
- NPI 1720105901
-
- Emergency Medicine Physician
- Ketchikan, AK
- NPI 1467088369
Affiliated clinicians 7
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1618358400000",
"number": "1003838384",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1687",
"city": "PALMER",
"state": "AK",
"postal_code": "996451687",
"telephone_number": "907-861-6000",
"fax_number": "907-861-6559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 S WOODWORTH LOOP",
"city": "PALMER",
"state": "AK",
"postal_code": "996458984",
"telephone_number": "907-861-6000",
"fax_number": "907-861-6559"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MAT SU VALLEY MEDICAL CENTER LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MAT SU VALLEY MEDICAL CENTER LLC",
"enumeration_date": "2006-07-24",
"last_updated": "2021-04-14",
"certification_date": "2021-04-14",
"status": "A",
"authorized_official_last_name": "LALOR",
"authorized_official_first_name": "PAULA",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "DIRECTOR/DELEGATED OFFICIAL",
"authorized_official_telephone_number": "629-215-3953"
},
"taxonomies": [
{
"code": "275N00000X",
"taxonomy_group": "",
"desc": "Medicare Defined Swing Bed Unit",
"state": "AK",
"license": "296969",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "HS47SB",
"state": "AK"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Mat-Su Regional Medical Center",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Mat-Su Regional Medical Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Palmer, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.