Central Peninsula General Hospital, Inc
Organization Active NPI Urology Physician · Soldotna, AK
NPI 1275948424 · NPPES record last updated Dec 7, 2020
Key facts
- NPI
- 1275948424
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Urology Physician 208800000X
- Legal business name
- CENTRAL PENINSULA GENERAL HOSPITAL, INC
- Practice address
- 240 Hospital PL
Ste 303a
Soldotna, AK 99669-7559 - Phone
- (907) 714-4404
- NPI assigned
- Jun 26, 2014
- Organization subpart
- Yes
- Parent organization (as reported)
- CENTRAL PENINSULA GENERAL HOSPITAL, INC
Authorized official
- Name
- Richard Davis
- Title
- Ceo
- Phone
- (907) 714-4723
Owners & managing parties with NPI records 7
-
Bradley T Cross, O.D.
-
Jesse Jennings Kincaid, M.D.
-
Michael L Reyes, MD
-
Jay Scott Rohloff, DDS
Other NPIs on the same Medicare enrollment 20
Related certifications (CCN) 1
Practitioners 12
-
Steven Ferrell, DO
-
Cindy K Nickels, FNP
-
Judy Lee Rohl, CRNA
-
Brian Uhlir, CRNA
-
Michael K Visick, MD
-
Lori D. Arney, D.O.
-
Daniel S Keck, P.A.
-
Robert E Cadoff, M.D.
Affiliated clinicians 387
-
David Abel, DO
-
Juliana Da Silva Abreu, P.A.
-
Ahmed S Abuzaid, MD
-
Samuel S. Adams, M.D.
-
Owen Aftreth, M.D.
-
David Carroll Albritton, FNP-C
-
Deryk Spencer Anderson, D.O.
-
Peter Ian Anderson, M.D.
-
John L Andreshak, M.D.
-
Jacinda Angulo, DNP
-
Richard A Anschuetz, M.D.
-
Naomi E Arenson, MD
-
Christine M Babcock, A.N.P.
-
Gladys Bailon, M.D.
-
Krzysztof W Balaban, M.D.
-
Katherine M Becher, FNP
-
Stacy Lee Beck, FNP, ARNP
-
Kira Bendixen, DO
Medicare Care Compare: Hospital
- Listed as
- Central Peninsula General Hospital
- Overall star rating
- ★★☆☆☆ 2 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Other
- Medicare certification status
- Active
- Emergency services
- Yes
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 02D2085378 | Central Peninsula Urology | Certificate of waiver | Aug 27, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AK
Hospital certification: CCN 020024
- Legal name
- CENTRAL PENINSULA GENERAL HOSPITAL INC
- Doing business as
- CENTRAL PENINSULA GENERAL HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Aug 5, 1971
- Last certification
- Aug 3, 2006
- Beds
- 49
- Ownership / control type
- Other
- Organization structure
- Corporation · Proprietary
- Incorporated
- Jan 1, 1993 in AK
- Enrollment address
- 250 Hospital PL
Soldotna, AK 99669-7559 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Carrie Couey |
Corporate Director |
Jan 1, 2020 | |
| Shaun Patrick Keef |
Corporate Officer |
Jan 11, 2019 | |
| W-2 Managing Employee |
Jan 11, 2019 | ||
| Michael Reyes |
Corporate Director |
Jan 1, 2023 | |
| Paul Ostrander |
Corporate Director |
Jan 1, 2022 | |
| Karl Hertz |
Corporate Officer |
Jun 16, 2025 | |
| Central Peninsula General Hospital Inc |
Operational/Managerial Control | Nov 26, 2007 | |
| Trena Richardson |
Corporate Director |
Jan 1, 2020 | |
| Jay S Rohloff |
Corporate Director |
Jan 1, 2021 | |
| Jesse J Kincaid |
Corporate Director |
Jan 1, 2022 | |
| Shanda Rochelle Richards |
W-2 Managing Employee |
Feb 8, 2021 | |
| Bradley T Cross |
Corporate Director |
Jan 1, 2023 | |
| Max Best |
Corporate Director |
Jan 1, 2021 | |
| Stephanie Queen |
Corporate Director |
Jan 1, 2023 | |
| Angela Hinnegan |
Corporate Officer |
Aug 1, 2025 | |
| Barb Belloumini |
Corporate Director | Jan 1, 2025 | |
| Silverio Mattero |
Corporate Director |
Jan 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040310000598 | AK | Part B Supplier - Clinic/Group Practice | 4587552575 |
Receives reassigned benefits from 136 practitioners 19 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Soldotna, AK; Kenai, AK |
| O20050609000176 | AK | Part a Provider - Hospital | 4587552575 |
18 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Soldotna, AK; Kenai, AK |
National Provider Directory
- Part of
- Cntrl Peninsula Gen Hos
Locations
245 N Binkley St
Soldotna, AK 99669
Phone (907) 714-4111
240 Hospital Pl
Ste 303A
Soldotna, AK 99669
Phone (907) 714-4404
Interoperability endpoints
- cc_acp_rt_urology_clinical_support_staff1225679@ak.providencedirect.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician |
208800000X | Yes | ||
| Rural Acute Care Hospital | 282NR1301X | GACH-003 | AK |
Addresses
Primary practice location
240 Hospital PL
Ste 303a
Soldotna, AK 99669-7559
Mailing address
250 Hospital PL
Soldotna, AK 99669-7559
Other names
- Central Peninsula Urology
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | cc_acp_rt_urology_clinical_support_staff1225679@ak.providencedirect.org |
Other providers in Soldotna, AK
- Central Peninsula General Hospital Inc.
- Central Peninsula General Hospital, Inc
- Central Peninsula General Hospital, Inc
- Central Peninsula General Hospital, Inc
- Central Peninsula General Hospital, Inc
- Central Peninsula General Hospital, Inc
- Central Peninsula General Hospital, Inc
- Central Peninsula General Hospital, Inc
- Central Peninsula General Hospital, Inc
- Central Peninsula General Hospital, Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 7, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.