Southcentral Foundation

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

SOUTHCENTRAL FOUNDATION

Doing business as

BSD- Dena A Coy

Practice address

4130 San Ernesto Ave
Anchorage, AK 99508-2875

Phone

(907) 729-5070

NPI assigned

May 20, 2006

Last updated

Apr 19, 2024By the provider in NPPES

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 Finance

Phone

(907) 729-4939

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• BSD- Dena A Coy Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Part of

Southcentral Foundation Nikolai Health Center

Practitioners 2

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.

• Darrel T. Hamel, LCSW

  • Clinical Social Worker
  • Anchorage, AK
  • NPI 1962736470
  NPD
• James Henkelman, LCSW, MSW

  • Clinical Social Worker
  • Anchorage, AK
  • NPI 1700056975
  NPD

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713484800000",
    "number": "1184678559",
    "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": "4130 SAN ERNESTO AVE",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995082875",
            "telephone_number": "907-729-5070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHCENTRAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHCENTRAL FOUNDATION",
        "enumeration_date": "2006-05-20",
        "last_updated": "2024-04-19",
        "certification_date": "2024-04-19",
        "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 FINANCE",
        "authorized_official_telephone_number": "907-729-4939"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1021095",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000855",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BSD- Dena A Coy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Southcentral Foundation (BH 1115- Adult Outpatient Services (200) AOS)
• Southcentral Foundation
• Southcentral Foundation (Care Coordination - Waiver Care Coordination)
• Southcentral Foundation (Tribal - KKGB ANTHC (Shared))
• Southcentral Foundation (Tribal- Fireweed)
• Southcentral Foundation (The Pathway Home Rendezvous)
• Southcentral Foundation
• Southcentral Foundation (Intensive Home Based Treatment)
• Southcentral Foundation (Dental- Children's Dental Clinic)
• Southcentral Foundation (SUD 1115- 4 Directions)

• Primary Care Clinic/Center in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Primary Care Clinic/Center in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2024; 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.