NPIMap

Organization Active NPI

Mat - Su Health Services Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wasilla, AK
National Provider Identifier
1184725210
Registry record updated Jun 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
MAT - SU HEALTH SERVICES INC.
Practice address
1363 W Spruce Ave
Wasilla, AK 99654-5327
Phone
(907) 376-2411
Fax
(907) 352-3363
NPI assigned
Sep 25, 2006
Last updated
Jun 10, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2010

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

Authorized official

Name
Mr. Kevin Munson
Title
Ceo
Phone
(907) 376-2411

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X AK Primary

Addresses

Primary practice location

1363 W Spruce Ave
Wasilla, AK 99654-5327

Mailing address

1363 W Spruce Ave
Wasilla, AK 99654-5327
Phone (907) 376-2411

Other identifiers 2

IdentifierTypeStateIssuer
RH779FQMedicaidAK
MH0469MedicaidAK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20040325000998 AK Part B Supplier - Clinic/Group Practice 2567354533 Receives reassigned benefits from 37 practitioners
Practice locations: Big Lake, AK; Wasilla, AK
O20100712000002 AK Part A Provider - Federally Qualified Health Center (FQHC) 2567354533 Practice locations: Wasilla, AK
O20150522002410 AK Part A Provider - Federally Qualified Health Center (FQHC) 2567354533 Practice locations: Palmer, AK
O20180921002944 AK Part A Provider - Federally Qualified Health Center (FQHC) 2567354533 Practice locations: Wasilla, AK
O20230612001765 AK Part A Provider - Federally Qualified Health Center (FQHC) 2567354533 Practice locations: Wasilla, AK

NPI to CCN mapping 4

The Medicare certification numbers (CCNs) connected to NPI 1184725210. Details of each certification follow.

Federally qualified health center certification: CCN 021831

Legal name
MAT - SU HEALTH SERVICES INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 17, 2005
Last certification
Nov 17, 2005
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 17, 1977 in AK
Enrollment address
1363 W Spruce Ave
Wasilla, AK 99654-5327

Federally qualified health center certification: CCN 021847

Legal name
MAT - SU HEALTH SERVICES INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 30, 2015
Last certification
Apr 30, 2015
Ownership / control type
Non-profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 13, 1977 in AK
Enrollment address
425 E Dahlia Ave
Ste M
Palmer, AK 99645-6463

Federally qualified health center certification: CCN 021853

Legal name
MAT - SU HEALTH SERVICES INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 2018
Last certification
Oct 1, 2018
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 13, 1977 in AK
Enrollment address
3261 S Big Lake Rd
Wasilla, AK 99623-9663

Federally qualified health center certification: CCN 021001

Legal name
MAT - SU HEALTH SERVICES INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 9, 2023
Last certification
Jun 9, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 13, 1977 in AK
Enrollment address
5801 E Bogard Rd
Wasilla, AK 99654-4267

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
02D1046987Mat-Su Health Services Inc1363 West Spruce Avenue, Wasilla, AK 99654Provider-performed microscopyOct 23, 2027

National Provider Directory

National Provider Directory

Locations

1363 W Spruce Ave
Wasilla, AK 99654
Phone (907) 376-2411

1775 W Parks Hwy
Wasilla, AK 99654
Phone (907) 864-2600

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Elena Shawback Individual Corporate OfficerCeo Mar 4, 2016 95%
Corporate OfficerCfo Feb 27, 2017 5%
Corporate OfficerCfo Dec 28, 2014 5%
W-2 Managing EmployeeCfo Dec 28, 2014 5%
Corporate OfficerCfo Dec 29, 2014 5%
Cassee Olin Individual Corporate OfficerCfo Sep 22, 2025 5%
Erin Leaders Individual Corporate Director Sep 23, 2025
Greg Parvin Individual Corporate DirectorDirector Dec 28, 2014
Corporate Director Dec 1, 2014
Corporate DirectorBoard Member Dec 18, 2014
Corporate DirectorBoard of Director President Elect Dec 15, 2014
Casey Cook Individual Corporate DirectorPresident Dec 1, 2014
Corporate Director Jul 22, 2022
Corporate DirectorBoard of Directors Jul 26, 2022
Susanne R Dillon Individual W-2 Managing Employee Jun 22, 2010
Loretta Cortis Individual Corporate Director Jan 8, 2025
Laura Pigg Individual Corporate Director Jun 22, 2010
Corporate Director May 1, 2006
Corporate DirectorBoard of Director May 15, 2006
Ryan Parker Individual Corporate Director Jan 8, 2025
Daryl Lowe Individual Corporate DirectorTreasurer, Secretary Jul 26, 2022
Corporate DirectorBoard of Directors Secretary Jul 26, 2022
Scott Sterling Individual Corporate Director Jun 1, 2020
Corporate DirectorBoard of Director President Jun 15, 2020
Olivia Freeman Individual Corporate Director Dec 20, 2020
Teri Tess Individual Corporate Director Feb 24, 2015
Corporate DirectorBoard Member - Treasurer Feb 24, 2015
Corporate DirectorBoard of Directors Feb 24, 2015
Lamarr Anderson Individual Corporate Director Apr 1, 2011
Corporate DirectorBoard Member Sep 20, 2018
Corporate DirectorBoard Member Sep 15, 2010
Kevin Munson Individual Corporate OfficerCeo Jun 22, 2010 5%
W-2 Managing EmployeeCeo Jun 22, 2010
Corporate OfficerCeo Jan 1, 2010 95%
W-2 Managing EmployeeCeo Jan 1, 2010 95%
W-2 Managing EmployeeCeo Jan 1, 2010 100%
Karen Kern Individual Corporate Director Mar 27, 2018
Corporate DirectorBoard Member Mar 27, 2018
Phil Horton Individual Corporate DirectorBoard Member - President Elect May 23, 2011
Sondra Kaplan Individual Corporate DirectorBoard Member - Secretary Feb 18, 2011
Amy Wilks Individual Corporate DirectorBoard Member - President Aug 24, 2013
Teresa Hurley Individual Corporate DirectorBoard of Directors Jul 26, 2022

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 112

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 112

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276128000000",
    "number": "1184725210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1363 W SPRUCE AVE",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996545327",
            "telephone_number": "907-376-2411",
            "fax_number": "907-352-3363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1363 W SPRUCE AVE",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996545327",
            "telephone_number": "907-376-2411",
            "fax_number": "907-352-3363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAT - SU HEALTH SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2010-06-10",
        "status": "A",
        "authorized_official_last_name": "MUNSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "907-376-2411",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "AK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RH779FQ",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MH0469",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wasilla, AK

Sources for this page

Verify at the official NPI Registry.