Southcentral Foundation

Primary specialty

Community Health Clinic/CenterTaxonomy code 261QC1500X

License

20467 Issued in AK

Legal business name

SOUTHCENTRAL FOUNDATION

Practice address

11495 N Callison Street
Sutton, AK 99674

Phone

(907) 631-7665

NPI assigned

Jan 10, 2014

Organization subpart

Yes

Parent organization

SOUTHCENTRAL FOUNDATIONAs reported in NPPES

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

Authorized official

Name

Ronald Lee Olson

Title

Executive Vice President of Finance

Phone

(907) 729-4939

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Tribal- Life House Community Health Center Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Part of

Anchorage Primary Care Clinic

Practitioners 5

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

• Marah Elizabeth Gotcsik, MD

  • Pediatrics Physician
  • Anchorage, AK
  • NPI 1275723108
  NPD
• Reinou Sybrecht Groen, M.D., M.I.H, PH.D.

  • Obstetrics & Gynecology Physician
  • Anchorage, AK
  • NPI 1740540517
  NPD
• Dajan Lefuel, PA-C

  • Physician Assistant
  • Anchorage, AK
  • NPI 1184338303
  NPD
• Jasen Russell Thompson, PA-C

  • Physician Assistant
  • Wasilla, AK
  • NPI 1033226998
  NPD
• David M Johnson, ARNP

  • Family Nurse Practitioner
  • Palmetto, FL
  • NPI 1922703818
  NPD

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

{
    "created_epoch": "1389312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693353600000",
    "number": "1043632037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35198",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981245198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11495 N CALLISON STREET",
            "city": "SUTTON",
            "state": "AK",
            "postal_code": "99674",
            "telephone_number": "907-631-7665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHCENTRAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHCENTRAL FOUNDATION",
        "enumeration_date": "2014-01-10",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT OF FINANCE",
        "authorized_official_telephone_number": "907-729-4939"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "AK",
            "license": "20467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1607931",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tribal- Life House Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chickaloon Native Villlage
• Sarah Ferroni, FNP
• Joanna Myers
• Rhoda Myers
• Pauline Ann Richard, L.C.S.W.
• Southcentral Foundation
• Southcentral Foundation
• Southcentral Foundation

• Community Health Clinic/Center in Sutton, AK
• Providers in Sutton, AK by specialty
• Community Health Clinic/Center in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 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.