NPIMap

Organization Active NPI

MC Children's Doctor

  • Pediatrics Physician
  • Bethel, AK
National Provider Identifier
1366251704
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MC CHILDREN'S DOCTOR
Practice address
9443 Ayaginar Dr.
Bethel, AK 99559
Phone
(970) 210-2944
NPI assigned
Dec 31, 2024
Last updated
Jan 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

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

Authorized official

Name
Dr. Cormac Arthur Sookram, MDNPI 1437491107
Title
Owner
Phone
(970) 210-2944

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

9443 Ayaginar Dr.
Bethel, AK 99559

Mailing address

PO Box 465
Bethel, AK 99559-0465
Phone (970) 210-2944

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1735603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737590400000",
    "number": "1366251704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 465",
            "city": "BETHEL",
            "state": "AK",
            "postal_code": "995590465",
            "telephone_number": "970-210-2944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9443 AYAGINAR DR.",
            "city": "BETHEL",
            "state": "AK",
            "postal_code": "99559",
            "telephone_number": "970-210-2944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MC CHILDREN'S DOCTOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-31",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A",
        "authorized_official_last_name": "SOOKRAM",
        "authorized_official_first_name": "CORMAC",
        "authorized_official_middle_name": "ARTHUR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "970-210-2944",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethel, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.