NPIMap

Organization Active NPI

Cordova Community Medical Center

  • Critical Access Hospital
  • Cordova, AK
National Provider Identifier
1215035787
Registry record updated Oct 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
CORDOVA COMMUNITY MEDICAL CENTER
Practice address
602 Chase Ave
Cordova, AK 99574-0160
Phone
(907) 424-8000
Fax
(907) 424-8116
NPI assigned
Sep 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2022

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

Authorized official

Name
Denna Stavig
Title
Director of Finance
Phone
(907) 424-8228

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X AK Primary
Nursing Facility/Intermediate Care Facility 313M00000X AK
Skilled Nursing Facility 314000000X AK
Land Ambulance 3416L0300X
Child Intellectual and/or Developmental Disabilities Respite Care 385HR2060X

Addresses

Primary practice location

602 Chase Ave
Cordova, AK 99574-0160

Mailing address

PO Box 160
602 Chase Ave
Cordova, AK 99574-0160
Phone (907) 424-8000

Other identifiers 11

IdentifierTypeStateIssuer
CM6143MedicaidAK
CM9745MedicaidAK
CMG287MedicaidAK
HS07IPMedicaidAK
0200927OtherAKNCPDP PHARM #
DA4455MedicaidAK
HC2871MedicaidAK
HS07OPMedicaidAK
MH6324MedicaidAK
HS07LTMedicaidAK
HS07SBMedicaidAK

Other names 1

  • CORDOVA COMMUNITY MEDICAL CENTER Doing business as

Owners & managing parties with NPI records 2

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

Practitioners 49

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

View all 49

Affiliated clinicians 12

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Cordova Community Medical CenterCCN 021307
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040210000439 AK Part B Supplier - Clinic/Group Practice 1759275902 Receives reassigned benefits from 48 practitioners
Practice locations: Cordova, AK
O20080112000203 AK Part A Provider - Critical Access Hospital 1759275902 Receives reassigned benefits from 39 practitioners
Practice locations: Cordova, AK
O20120311000001 AK Part A Provider - Critical Access Hospital 1759275902 Practice locations: Cordova, AK

Hospital certification: CCN 021307

Legal name
CORDOVA COMMUNITY MEDICAL CENTER
Doing business as
CORDOVA COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 1, 2003
Last certification
Mar 25, 2022
Beds
13
Ownership / control type
Local
Organization structure
GovernmentNon-profit
Enrollment address
602 Chase Ave
Cordova, AK 99574-0160

Hospital certification: CCN 02Z307

Legal name
CORDOVA COMMUNITY MEDICAL CENTER
Doing business as
CORDOVA COMMUNITY HOSPITAL
Organization structure
GovernmentNon-profit
Enrollment address
602 Chase Ave
Cordova, AK 99574-0160
Other Hospital Practice Location

All disclosed owners & managing parties 3

Medicare enrollment files

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

NameRoleSinceShare
City of Cordova Organization, Cordova, AK 5% Or Greater Direct Ownership Interest Sep 20, 2006 100%
Hannah J Sanders Individual Corporate OfficerCeo May 15, 2020 100%
W-2 Managing EmployeeAd; May 15, 2020
Alieta M Bond Individual W-2 Managing EmployeeCredentialing/Enrollment Feb 1, 2020

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/cordova-527880fe

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664841600000",
    "number": "1215035787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 160",
            "address_2": "602 CHASE AVE",
            "city": "CORDOVA",
            "state": "AK",
            "postal_code": "995740160",
            "telephone_number": "907-424-8000",
            "fax_number": "907-424-8116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 CHASE AVE",
            "city": "CORDOVA",
            "state": "AK",
            "postal_code": "995740160",
            "telephone_number": "907-424-8000",
            "fax_number": "907-424-8116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORDOVA COMMUNITY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A",
        "authorized_official_last_name": "STAVIG",
        "authorized_official_first_name": "DENNA",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "907-424-8228"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "AK",
            "license": null,
            "primary": true
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "AK",
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AK",
            "license": null,
            "primary": false
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CM6143",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CM9745",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMG287",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HS07IP",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PHARM #",
            "identifier": "0200927",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DA4455",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HC2871",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HS07OP",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MH6324",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HS07LT",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HS07SB",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CORDOVA COMMUNITY MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CORDOVA COMMUNITY MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cordova, AK

Sources for this page

Verify at the official NPI Registry.