NPIMap

Organization Active NPI

Maniilaq Association

Doing business as Shungnak Clinic

  • Federal Public Health Clinic/Center
  • Shungnak, AK
National Provider Identifier
1376810937
Registry record updated Nov 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federal Public Health Clinic/CenterTaxonomy code 261QP0904X
Legal business name
MANIILAQ ASSOCIATION
Doing business as
Shungnak Clinic
Practice address
80 Back St.
Shungnak, AK 99773-0080
Phone
(907) 437-2138
Fax
(907) 437-2139
NPI assigned
Nov 28, 2011
Last updated
Nov 28, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
MANIILAQ ASSOCIATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 28, 2011

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

Authorized official

Name
Mr. Paul John Hansen
Title
Deputy Administrator
Phone
(907) 442-7150

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federal Public Health Clinic/Center 261QP0904X NU Primary

Addresses

Primary practice location

80 Back St.
Shungnak, AK 99773-0080

Mailing address

P.O. Box 43
Kotzebue, AK 99752-0043
Phone (907) 442-7150

Other names 1

  • Shungnak Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, AK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041123000372 TX Part B Supplier - Clinic/Group Practice 6103881792 Receives reassigned benefits from 218 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Shungnak, AK; Selawik, AK; PT Hope, AK; Noorvik, AK; Noatak, AK; Kotzebue, AK; Kobuk, AK; Ambler, AK…
O20120119000556 AK Part A Provider - Critical Access Hospital 6103881792 Receives reassigned benefits from 73 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kotzebue, AK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376810937. Details of each certification follow.

Hospital certification: CCN 021310

Legal name
MANIILAQ ASSOCIATION
Doing business as
MANIILAQ HEALTH CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Feb 1, 2005
Last certification
Aug 28, 2025
Beds
17
Ownership / control type
Tribal
Organization structure
OtherNon-profit
Incorporated
Jan 23, 1997 in AK
Enrollment address
436 5TH Ave
Kotzebue, AK 99752-0043
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 13

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

View all 13

Care Compare: Hospital

Medicare Care Compare
Listed as
Maniilaq Health CenterCCN 021310 · All quality measures
Type
Critical Access Hospitals
Ownership
Tribal
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
Ambler Clinic

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Johnetta Horner Individual Corporate DirectorBoard Member Apr 25, 2018 8.33%
Erin Jacobs Individual Corporate OfficerDeputy Dir Patient Financial Ser Jul 15, 2018
Tanya Kirk Individual Corporate DirectorBoard Member Apr 25, 2018 8.33%
Percy Ballot Individual Corporate DirectorBoard Member Oct 28, 2008 8.33%
Paul Hansen Individual W-2 Managing EmployeeHospital Administrator Oct 1, 2013
Dolly Foster Individual Corporate DirectorBoard Member Apr 25, 2018 8.33%
Guy L Adams Individual Corporate DirectorBoard Member Jan 20, 2012 8.33%
Amanda Johnson Individual Corporate DirectorBoard Member Apr 25, 2018 8.33%
Eva Kinneeveauk Individual Corporate DirectorBoard Member May 29, 2012 8.33%
Emerson Moto Individual Corporate DirectorBoard Member Feb 19, 2005 8.33%
Tim Gilbert Individual Corporate OfficerCeo Jun 12, 2017 100%
Lorena Walker Individual Corporate DirectorBoard Member Apr 25, 2018 8.33%
Diana Ramoth Individual Corporate DirectorBoard Member Apr 25, 2018 8.33%

Practitioners & affiliated clinicians

Practitioners 20

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 20

Affiliated clinicians 80

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 80

NPI Registry JSON

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

{
    "created_epoch": "1322438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322438400000",
    "number": "1376810937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 43",
            "city": "KOTZEBUE",
            "state": "AK",
            "postal_code": "997520043",
            "telephone_number": "907-442-7150",
            "fax_number": "907-442-7250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 BACK ST.",
            "city": "SHUNGNAK",
            "state": "AK",
            "postal_code": "997730080",
            "telephone_number": "907-437-2138",
            "fax_number": "907-437-2139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANIILAQ ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MANIILAQ ASSOCIATION",
        "enumeration_date": "2011-11-28",
        "last_updated": "2011-11-28",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "DEPUTY ADMINISTRATOR",
        "authorized_official_telephone_number": "907-442-7150",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP0904X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, Federal",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shungnak Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shungnak, AK

Sources for this page

Verify at the official NPI Registry.