NPIMap

Organization Active NPI

Kenaitze Indian Tribe

Doing business as Denaina Dental Clinic

  • Federally Qualified Health Center (FQHC)
  • Kenai, AK
National Provider Identifier
1295972677
Registry record updated Dec 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
KENAITZE INDIAN TRIBE
Doing business as
Denaina Dental Clinic
Practice address
508 Upland St
Kenai, AK 99611-8026
Phone
(907) 335-7500
Fax
(907) 335-2155
NPI assigned
Jan 7, 2009
Last updated
Dec 2, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
KENAITZE INDIAN TRIBEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 2, 2024

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

Authorized official

Name
Greg Burnett
Title
Finance Director
Phone
(907) 335-7200

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Dentist 122300000X IHS AK
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X NU

Addresses

Primary practice location

508 Upland St
Kenai, AK 99611-8026

Mailing address

PO Box 988
Kenai, AK 99611-0988
Phone (907) 335-7500

Other identifiers 2

IdentifierTypeStateIssuer
DDG020MedicaidAK
021855OtherAKFQHC CERTIFICATION NUMBER

Other names 2

  • Denaina Dental Clinic Doing business as
  • Denaina Wellness Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040325000198 AK Part B Supplier - Clinic/Group Practice 4082506225 Receives reassigned benefits from 40 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kenai, AK; Soldotna, AK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295972677. Details of each certification follow.

  • CCN 021855 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 021855

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
DENAINA WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 24, 2020
Last certification
Jan 24, 2020
Ownership / control type
Non-profit – corporation
Facility address
508 Upland St
Kenai, AK 99611

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Kenaitze Indian Tribe

Locations

412 Frontage Rd
Ste 20
Kenai, AK 99611
Phone (907) 335-2100

416 Frontage Rd
#200
Kenai, AK 99611
Phone (907) 283-6030

Interoperability endpoints

  • Direct secure messaging: adoberstein@direct.kenaitze.org
  • Direct secure messaging: cjcaraher@direct.kenaitze.org
  • Direct secure messaging: djspoerle@direct.kenaitze.org
  • Direct secure messaging: khzook@direct.kenaitze.org
  • Direct secure messaging: lchamilton@direct.kenaitze.org
  • Direct secure messaging: lfrederickson@direct.kenaitze.org
  • Direct secure messaging: mclincoln@direct.maniilaq.org
  • Direct secure messaging: mcmallatt@direct.kenaitze.org
  • Direct secure messaging: nksaltzgiver@direct.kenaitze.org
  • Direct secure messaging: rnassar@direct.kenaitze.org
  • Direct secure messaging: wphillips@direct.kenaitze.org

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 39

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 39

NPI Registry JSON

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

{
    "created_epoch": "1231286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733097600000",
    "number": "1295972677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 988",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "996110988",
            "telephone_number": "907-335-7500",
            "fax_number": "907-335-2155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 UPLAND ST",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "996118026",
            "telephone_number": "907-335-7500",
            "fax_number": "907-335-2155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENAITZE INDIAN TRIBE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KENAITZE INDIAN TRIBE",
        "enumeration_date": "2009-01-07",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A",
        "authorized_official_last_name": "BURNETT",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "FINANCE DIRECTOR",
        "authorized_official_telephone_number": "907-335-7200"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AK",
            "license": "IHS",
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DDG020",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FQHC CERTIFICATION NUMBER",
            "identifier": "021855",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Denaina Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Denaina Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Denaina Wellness Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kenai, AK

Sources for this page

Verify at the official NPI Registry.