NPIMap

Organization Active NPI

South Peninsula Hospital, Inc

  • Critical Access Hospital
  • Homer, AK
National Provider Identifier
1093968372
Registry record updated Jun 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
192072 Issued in AK
Legal business name
SOUTH PENINSULA HOSPITAL, INC
Practice address
4300 Bartlett St
Homer, AK 99603-7005
Phone
(907) 235-8101
Fax
(907) 235-0253
NPI assigned
Oct 30, 2008
Last updated
Jun 22, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2026

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

Authorized official

Name
Mr. Ryan Smith
Title
Chief Executive Officer
Phone
(907) 235-0241

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital Clinic/Center 261QC0050X
Urgent Care Clinic/Center 261QU0200X
Medicare Defined Swing Bed Hospital Unit 275N00000X 192072 AK
General Acute Care Hospital 282N00000X
Critical Access Hospital 282NC0060X 192072 AK Primary
Nursing Facility/Intermediate Care Facility 313M00000X
Skilled Nursing Facility 314000000X

Addresses

Primary practice location

4300 Bartlett St
Homer, AK 99603-7005

Mailing address

4300 Bartlett St
Homer, AK 99603-7005
Phone (907) 235-8101

Other practice location 1

4201 Bartlett St Ste 202
Homer, AK 99603-7015
Phone (907) 235-0229

Other practice location 2

205 W Fairview Ave
Homer, AK 99603-7032
Phone (907) 226-5600

Other practice location 3

4136 Bartlett St
Homer, AK 99603-7001
Phone (907) 235-8586

Other practice location 4

4300 Bartlett St
Homer, AK 99603-7005
Phone (907) 226-5630

Other practice location 5

263 W Fairview Ave
Homer, AK 99603-7032
Phone (907) 435-3070

Other practice location 6

4201 Bartlett St Ste 201
Homer, AK 99603-7015
Phone (907) 235-0310

Other practice location 7

4251 Bartlett St
Homer, AK 99603-7006
Phone (907) 235-0201

Other practice location 8

3726 Lake St Ste G
Homer, AK 99603-7663
Phone (907) 235-0370

Other practice location 9

3714 Greatland St
Homer, AK 99603-7522
Phone (907) 235-7202

Other practice location 10

4201 Bartlett St Ste 202
Homer, AK 99603-7015
Phone (907) 235-0900

Other identifiers 13

IdentifierTypeStateIssuer
1687514MedicaidAK
1005654MedicaidAK
1582637MedicaidAK
1005186MedicaidAK
1020634MedicaidAK
1028527MedicaidAK
1582664MedicaidAK
1687518MedicaidAK
1755753MedicaidAK
1701931MedicaidAK
1738615MedicaidAK
1005653MedicaidAK
1756683MedicaidAK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070911000138 AK Part A Provider - Critical Access Hospital 5395636930 Receives reassigned benefits from 84 practitioners
Practice locations: Homer, AK
O20071023000441 AK Part A Provider - Critical Access Hospital 5395636930 Receives reassigned benefits from 1 practitioner
Practice locations: Homer, AK

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1093968372. Details of each certification follow.

Hospital certification: CCN 021313

Legal name
SOUTH PENINSULA HOSPITAL INC
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Aug 7, 2008
Last certification
Nov 17, 2021
Beds
22
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
4300 Bartlett St
Homer, AK 99603-7005
Main/Primary Hospital Location

Hospital certification: CCN 02Z313

Legal name
SOUTH PENINSULA HOSPITAL INC
Organization structure
CorporationNon-profit
Incorporated
Sep 18, 1961 in AK
Enrollment address
4300 Bartlett St
Homer, AK 99603-7005

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospital

Medicare Care Compare
Listed as
South Peninsula HospitalCCN 021313 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
South Peninsula Hosp4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

263 W Fairview Ave
Homer, AK 99603
Phone (907) 435-3030

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/sphosp-0c203fcf

Ownership & related parties

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Preston M Simmons Individual Corporate DirectorVice President Jan 24, 2024
Corporate DirectorDirector Jan 24, 2024
Kelly Gallios Individual W-2 Managing Employee Mar 6, 2023
Mary Wythe Individual Corporate DirectorSecretary Jan 1, 2020
Corporate DirectorBoard of Directors Secretary Jan 1, 2020
Edson Knapp Individual Corporate DirectorDirector - Physician Seat Mar 1, 2020
Corporate DirectorDirector - Physicians Seat Mar 1, 2020
Michael Dye Individual Corporate DirectorTreasurer Sep 25, 2024
Corporate DirectorDirector Sep 25, 2024
Christopher a Landess Individual Corporate DirectorDirector - Physician May 22, 2024
Anna Hermanson Individual Corporate OfficerChief Financial Officer Jan 25, 2023
W-2 Managing EmployeeFinance and Revenue Cycle Director Nov 16, 2016
South Peninsula Hospital Inc Organization, Homer, AK Non-profit Operational/Managerial Control Aug 9, 2007 100%
Operational/Managerial Control Sep 23, 2007 100%
Ryan Smith Individual Corporate OfficerCeo Jul 29, 2019
Jim Anderson Individual Corporate DirectorDirector Jan 1, 2026
Aaron Weisser Individual Corporate DirectorPresident Jan 26, 2022
Corporate DirectorBoard of Directors President Jan 1, 2022
Kim Frost Individual Corporate DirectorDirector Jan 29, 2025
Rachael B Kincaid Individual Corporate OfficerChief Operating Officer Jul 13, 2025
Matthew Bullard Individual Corporate DirectorDirector Jan 24, 2024
Kenneth Ciccoli Individual Corporate DirectorDirector Jan 1, 2026
Amber Gall Individual Corporate DirectorChief Nursing Officer Jul 13, 2025
Corporate OfficerChief Nursing Officer Jul 13, 2025
Bernadette Wilson Individual Corporate DirectorDirector Nov 1, 2006

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
South Peninsula Hospital IncHomer, AK, CCN 025031 Skilled nursing facility Operational/Managerial Control (100%) Apr 12, 2008
South Peninsula Hospital Home HealthHomer, AK, CCN 027010 Home health agency Operational/Managerial Control (100%) Nov 30, 2017

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 86

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 86

Affiliated clinicians 147

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 147

NPI Registry JSON

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

{
    "created_epoch": "1225324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782086400000",
    "number": "1093968372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 BARTLETT ST",
            "city": "HOMER",
            "state": "AK",
            "postal_code": "996037005",
            "telephone_number": "907-235-8101",
            "fax_number": "907-235-0253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 BARTLETT ST",
            "city": "HOMER",
            "state": "AK",
            "postal_code": "996037005",
            "telephone_number": "907-235-8101",
            "fax_number": "907-235-0253"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4201 Bartlett St Ste 202",
            "address_purpose": "LOCATION",
            "city": "Homer",
            "state": "AK",
            "postal_code": "996037015",
            "country_code": "US",
            "telephone_number": "907-235-0229",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "205 W Fairview Ave",
            "address_purpose": "LOCATION",
            "city": "Homer",
            "state": "AK",
            "postal_code": "996037032",
            "country_code": "US",
            "telephone_number": "907-226-5600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4136 Bartlett St",
            "address_purpose": "LOCATION",
            "city": "Homer",
            "state": "AK",
            "postal_code": "996037001",
            "country_code": "US",
            "telephone_number": "907-235-8586",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4300 Bartlett St",
            "address_purpose": "LOCATION",
            "city": "Homer",
            "state": "AK",
            "postal_code": "996037005",
            "country_code": "US",
            "telephone_number": "907-226-5630",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "263 W Fairview Ave",
            "address_purpose": "LOCATION",
            "city": "Homer",
            "state": "AK",
            "postal_code": "996037032",
            "country_code": "US",
            "telephone_number": "907-435-3070",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4201 Bartlett St Ste 201",
            "address_purpose": "LOCATION",
            "city": "Homer",
            "state": "AK",
            "postal_code": "996037015",
            "country_code": "US",
            "telephone_number": "907-235-0310",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4251 Bartlett St",
            "address_purpose": "LOCATION",
            "city": "Homer",
            "state": "AK",
            "postal_code": "996037006",
            "country_code": "US",
            "telephone_number": "907-235-0201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3726 Lake St Ste G",
            "address_purpose": "LOCATION",
            "city": "Homer",
            "state": "AK",
            "postal_code": "996037663",
            "country_code": "US",
            "telephone_number": "907-235-0370",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3714 Greatland St",
            "address_purpose": "LOCATION",
            "city": "Homer",
            "state": "AK",
            "postal_code": "996037522",
            "country_code": "US",
            "telephone_number": "907-235-7202",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4201 Bartlett St Ste 202",
            "address_purpose": "LOCATION",
            "city": "Homer",
            "state": "AK",
            "postal_code": "996037015",
            "country_code": "US",
            "telephone_number": "907-235-0900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTH PENINSULA HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-30",
        "last_updated": "2026-06-22",
        "certification_date": "2026-06-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "907-235-0241",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QC0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Critical Access Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "AK",
            "license": "192072",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "AK",
            "license": "192072",
            "primary": true
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1687514",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1005654",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1582637",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1005186",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1020634",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1028527",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1582664",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1687518",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1755753",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1701931",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1738615",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1005653",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1756683",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Homer, AK

Sources for this page

Verify at the official NPI Registry.