Southcentral Foundation

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

SOUTHCENTRAL FOUNDATION

Doing business as

Tribal- Centennial Center Clinic

Practice address

9131 Centennial Cir
Anchorage, AK 99504-1482

Phone

(907) 729-4955

NPI assigned

Nov 23, 2021

Organization subpart

Yes

Parent organization

SOUTHCENTRAL FOUNDATIONAs reported in NPPES

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

Authorized official

Name

Ronald Lee Olson

Title

Executive Vice President Finance

Phone

(907) 729-4939

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Tribal- Centennial Center Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Part of

Anchorage Primary Care Clinic

Practitioners 4

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

• Kristin K Campbell, OT

  • Occupational Therapist
  • Anchorage, AK
  • NPI 1356853329
  NPD
• Meera Davenport, PT, DPT

  • Physical Therapist
  • Anchorage, AK
  • NPI 1093113904
  NPD
• Matthew James Hirschfeld, MD

  • Pediatrics Physician
  • Anchorage, AK
  • NPI 1679683213
  NPD
• Julia Koval

  • Midwife
  • Anchorage, AK
  • NPI 1053874388
  NPD

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

{
    "created_epoch": "1637625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693526400000",
    "number": "1306503578",
    "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": "9131 CENTENNIAL CIR",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995041482",
            "telephone_number": "907-729-4955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHCENTRAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHCENTRAL FOUNDATION",
        "enumeration_date": "2021-11-23",
        "last_updated": "2023-09-01",
        "certification_date": "2023-09-01",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT FINANCE",
        "authorized_official_telephone_number": "907-729-4939"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1728771",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tribal- Centennial Center Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Southcentral Foundation (HPG- Chap Group)
• Southcentral Foundation (BSD- FASD Clinic)
• Southcentral Foundation (BSD- Detox)
• Southcentral Foundation (BH 1115- Icm)
• Southcentral Foundation (BH- PCC)
• Southcentral Foundation (Dental- Fireweed Dental Clinic)
• Southcentral Foundation (Pharmacy- RASU)
• Southcentral Foundation (Behavioral Health Aide Practioner Group)
• Southcentral Foundation (Dental- Dental on 36th)
• Southcentral Foundation (Tribal Targeted Case Management Clinic)

• Multi-Specialty Clinic/Center in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Multi-Specialty Clinic/Center in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2023; 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.