NPIMap

Organization Active NPI

Bristol Bay Area Health Corporation

Doing business as Bristol Bay Area Health Corporation Vision Group

  • Optometrist
  • Dillingham, AK
National Provider Identifier
1154551588
Registry record updated Nov 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
BRISTOL BAY AREA HEALTH CORPORATION
Doing business as
Bristol Bay Area Health Corporation Vision Group
Practice address
6000 Kanakanak Rd
Dillingham, AK 99576
Phone
(907) 842-9201
Fax
(907) 842-9203
NPI assigned
Jul 20, 2009
Last updated
Nov 9, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
BRISTOL BAY AREA HEALTH CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 9, 2023

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

Authorized official

Name
Robert J Clark
Title
Chief Executive Officer
Phone
(907) 842-5201

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X Primary

Addresses

Primary practice location

6000 Kanakanak Rd
Dillingham, AK 99576

Mailing address

PO Box 130
Dillingham, AK 99576
Phone (907) 842-9203

Other names 1

  • Bristol Bay Area Health Corporation Vision Group Doing business as

Medicare participation

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

Enrollment records 1

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…

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
Tax ID family
Bristol Bay Area Health Corportion42 organizations share this tax ID, including this one
Part of
Bristol Bay Area Health Corportion

Other organizations with this tax ID 41

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

View all 41

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1248048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699488000000",
    "number": "1154551588",
    "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": "99576",
            "telephone_number": "907-842-9203",
            "fax_number": "907-842-9201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 KANAKANAK RD",
            "city": "DILLINGHAM",
            "state": "AK",
            "postal_code": "99576",
            "telephone_number": "907-842-9201",
            "fax_number": "907-842-9203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRISTOL BAY AREA HEALTH CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRISTOL BAY AREA HEALTH CORPORATION",
        "enumeration_date": "2009-07-20",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF  EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "907-842-5201"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bristol Bay Area Health Corporation Vision Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bristol Bay Area Health Corporation Vision Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dillingham, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 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.