NPIMap

Organization Active NPI

Southcentral Foundation

Doing business as BH 1115- Icm

  • Community/Behavioral Health Agency
  • Anchorage, AK
National Provider Identifier
1275186975
Registry record updated Sep 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
SOUTHCENTRAL FOUNDATION
Doing business as
BH 1115- Icm
Sud/BH 1115- Icm
Practice address
400 W Benson Blvd
Anchorage, AK 99503-3829
Phone
(907) 729-5418
Fax
(907) 729-8607
NPI assigned
Jul 22, 2019
Last updated
Sep 25, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHCENTRAL FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 25, 2025

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

Authorized official

Name
Lee Olson
Title
Executive VP Finance
Phone
(907) 729-4939

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

400 W Benson Blvd
Anchorage, AK 99503-3829

Mailing address

PO Box 35198
Seattle, WA 98124-5198

Other identifiers 1

IdentifierTypeStateIssuer
1696879MedicaidAK

Other names 2

  • BH 1115- ICM Doing business as
  • SUD/BH 1115- ICM Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051027000416 TX Part B Supplier - Clinic/Group Practice 5496663627 Receives reassigned benefits from 534 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Anchorage, AK; Chugiak, AK; Fairbanks, AK; Igiugig, AK; Iliamna, AK; Kockhanok, AK; McGrath, AK; Nondalton, AK…

National Provider Directory

National Provider Directory
Tax ID family
Southcentral Foundation PDN103 organizations share this tax ID, including this one
Part of
Southcentral Foundation PDN

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1563753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758758400000",
    "number": "1275186975",
    "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": "400 W BENSON BLVD",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995033829",
            "telephone_number": "907-729-5418",
            "fax_number": "907-729-8607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHCENTRAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHCENTRAL FOUNDATION",
        "enumeration_date": "2019-07-22",
        "last_updated": "2025-09-25",
        "certification_date": "2025-09-25",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "EXECUTIVE VP FINANCE",
        "authorized_official_telephone_number": "907-729-4939"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1696879",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BH 1115- ICM",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SUD/BH 1115- ICM",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Anchorage, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2025; 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.