NPIMap

Organization Active NPI

The Petersburg Medical Center

  • Skilled Nursing Facility
  • Petersburg, AK
National Provider Identifier
1104984954
Registry record updated Jan 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
THE PETERSBURG MEDICAL CENTER
Practice address
103 Fram Street
Petersburg, AK 99833-0589
Phone
(907) 772-4291
Fax
(907) 772-3085
NPI assigned
Dec 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2013

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

Authorized official

Name
Elizabeth L Woodyard
Title
Ceo
Phone
(907) 772-4291

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X AK Primary

Addresses

Primary practice location

103 Fram Street
Petersburg, AK 99833-0589

Mailing address

PO Box 589
Petersburg, AK 99833-0589
Phone (907) 772-4291

Other identifiers 1

IdentifierTypeStateIssuer
HS09LTMedicaidAK

Other names 1

  • Petersburg General Hospital Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060302000434 AK Part A Provider - Skilled Nursing Facility 5395730626 Practice locations: Petersburg, AK

Skilled nursing facility certification: CCN 025019

Legal name
THE PETERSBURG MEDICAL CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1981
Last certification
Mar 11, 2024
Beds
15
Ownership / control type
City/County
Organization structure
OtherNon-profit
Enrollment address
103 Fram St
Box 589
Petersburg, AK 99833-0589
Nursing home name
PETERSBURG MEDICAL CENTER LTC

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Petersburg Medical Center LTCCCN 025019
Overall star rating
5 of 5
Health inspections
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Government - City/county
Certified
Jan 1, 1981
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
1510.8 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
The Petersburg Medical Center6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Philip Hofstetter Individual Operational/Managerial Control Jan 16, 2019
Adp of the SNF Jan 16, 2019
Individual Adp of the SNF Jan 16, 2019
The Petersburg Medical Center Organization, Petersburg, AK Operational/Managerial Control Dec 19, 2006
Direct Ownership Interest Dec 9, 2006 100%

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
The Petersburg Medical CenterPetersburg, AK, CCN 02Z304 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 3, 2013
The Petersburg Medical CenterPetersburg, AK, CCN 027009 Home health agency 5% Or Greater Direct Ownership Interest (100%) Jan 3, 2013

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 6

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

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358467200000",
    "number": "1104984954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 589",
            "city": "PETERSBURG",
            "state": "AK",
            "postal_code": "998330589",
            "telephone_number": "907-772-4291",
            "fax_number": "907-772-3085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 FRAM STREET",
            "city": "PETERSBURG",
            "state": "AK",
            "postal_code": "998330589",
            "telephone_number": "907-772-4291",
            "fax_number": "907-772-3085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PETERSBURG MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2013-01-18",
        "status": "A",
        "authorized_official_last_name": "WOODYARD",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "907-772-4291"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HS09LT",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Petersburg General Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Petersburg, AK

Sources for this page

Verify at the official NPI Registry.