NPIMap

Organization Active NPI

Bristol Bay Area Health Corporation

  • Clinic/Center
  • Koliganek, AK
National Provider Identifier
1013079607
Registry record updated Oct 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
BRISTOL BAY AREA HEALTH CORPORATION
Practice address
5060 Main Street
Koliganek, AK 99576
Phone
(907) 842-5201
Fax
(907) 842-9250
NPI assigned
Dec 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2023

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

Authorized official

Name
Mr. Robert Clark
Title
Ceo
Phone
(907) 842-5201

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

5060 Main Street
Koliganek, AK 99576

Mailing address

PO Box 130
Dillingham, AK 99576-0130
Phone (907) 842-5201

Other identifiers 2

IdentifierTypeStateIssuer
1020782MedicaidAK
TEZ153OtherAKMEDICARE ID-TYPE UNSPECIFIED

Other names 1

  • KOLIGANEK CLINIC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031120000998 TX Part B Supplier - Clinic/Group Practice 5890699920 Receives reassigned benefits from 432 practitioners
44 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lebelock, AK; Manokotak, AK; Goodnews Bay, AK; Naknek, AK; New Stuyahok, AK; Perryville, AK; Pilot Point, AK; Platinum, AK…
O20190304000785 TX Part B Supplier - Mass Immunization (Roster Biller Only) 5890699920 21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Goodnews Bay, AK; Twin Hills, AK; Togiak, AK; South Naknek, AK; Port Heiden, AK; Platinum, AK; Pilot Point, AK; Perryville, AK…

Other NPIs on the same Medicare enrollment 38

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 38

National Provider Directory

National Provider Directory

Practitioners 322

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 322

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696550400000",
    "number": "1013079607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "DILLINGHAM",
            "state": "AK",
            "postal_code": "995760130",
            "telephone_number": "907-842-5201",
            "fax_number": "907-842-9250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5060 MAIN STREET",
            "city": "KOLIGANEK",
            "state": "AK",
            "postal_code": "99576",
            "telephone_number": "907-842-5201",
            "fax_number": "907-842-9250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRISTOL BAY AREA HEALTH CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-05",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "907-842-5201",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1020782",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-TYPE UNSPECIFIED",
            "identifier": "TEZ153",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KOLIGANEK CLINIC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "KOLIGANEK CLINIC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Koliganek, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.