NPIMap

Organization Active NPI

Southcentral Foundation

Doing business as Tribal- Kokhanok Community Health Clinic

  • Community Health Clinic/Center
  • Kokhanok, AK
National Provider Identifier
1043689169
Registry record updated Aug 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
License
20467 Issued in AK
Legal business name
SOUTHCENTRAL FOUNDATION
Doing business as
Tribal- Kokhanok Community Health Clinic
Practice address
1008 Main Street
Kokhanok, AK 99606
Phone
(907) 282-2203
NPI assigned
Sep 18, 2015
Last updated
Aug 30, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHCENTRAL FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 30, 2023

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

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X 20467 AK Primary

Addresses

Primary practice location

1008 Main Street
Kokhanok, AK 99606

Mailing address

PO Box 35198
Seattle, WA 98124-5198

Other identifiers 1

IdentifierTypeStateIssuer
1637733MedicaidAK

Other names 1

  • Tribal- Kokhanok Community Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051027000416 TX Part B Supplier - Clinic/Group Practice 5496663627 Receives reassigned benefits from 534 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Anchorage, AK; Chugiak, AK; Fairbanks, AK; Igiugig, AK; Iliamna, AK; Kockhanok, AK; McGrath, AK; Nondalton, AK…

National Provider Directory

National Provider Directory
Part of
Southcentral Foundation Nikolai Health Center

Practitioners & affiliated clinicians

Practitioners 148

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.

View all 148

NPI Registry JSON

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

{
    "created_epoch": "1442534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693353600000",
    "number": "1043689169",
    "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": "1008 MAIN STREET",
            "city": "KOKHANOK",
            "state": "AK",
            "postal_code": "99606",
            "telephone_number": "907-282-2203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHCENTRAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHCENTRAL FOUNDATION",
        "enumeration_date": "2015-09-18",
        "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": "1637733",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tribal- Kokhanok Community Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kokhanok, AK

Sources for this page

  • 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.