NPIMap

Organization Active NPI

Fairbanks Memorial Cardiology Center, LLC

  • Multi-Specialty Clinic/Center
  • Fairbanks, AK
National Provider Identifier
1386193472
Registry record updated Apr 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
FAIRBANKS MEMORIAL CARDIOLOGY CENTER, LLC
Practice address
1650 Cowles St Dept 60a
Fairbanks, AK 99701-5907
Phone
(907) 458-5525
NPI assigned
Sep 29, 2016
Last updated
Apr 14, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
FOUNDATION HEALTH LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 14, 2026

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

Authorized official

Name
Anthony G Suduth, CPA, FHFMA, FACHE
Title
Cfo
Phone
(907) 458-3310

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary
Medical Specialty Clinic/Center 261QM2500X

Addresses

Primary practice location

1650 Cowles St Dept 60a
Fairbanks, AK 99701-5907

Mailing address

1650 Cowles St Dept 60a
Fairbanks, AK 99701-5907
Phone (907) 458-5525

Other practice location 1

1919 Lathrop St
Fairbanks, AK 99701-5937
Phone (907) 458-3346

Other identifiers 1

IdentifierTypeStateIssuer
1656021MedicaidAK

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmdprod.craneware.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Serivce Other Craneware, Inc

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170106000686 AK Part B Supplier - Clinic/Group Practice 0244511269 Receives reassigned benefits from 32 practitioners
Practice locations: Fairbanks, AK

National Provider Directory

National Provider Directory
Part of
Foundation Health LLC

Locations

1650 Cowles St
#60A
Fairbanks, AK 99701
Phone (907) 458-5525

1919 Lathrop St
Fairbanks, AK 99701
Phone (907) 459-3570

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 43

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 43

NPI Registry JSON

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

{
    "created_epoch": "1475107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776124800000",
    "number": "1386193472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 COWLES ST DEPT 60A",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015907",
            "telephone_number": "907-458-5525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 COWLES ST DEPT 60A",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015907",
            "telephone_number": "907-458-5525"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1919 Lathrop St",
            "address_purpose": "LOCATION",
            "city": "Fairbanks",
            "state": "AK",
            "postal_code": "997015937",
            "country_code": "US",
            "telephone_number": "907-458-3346",
            "fax_number": "907-458-5011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FAIRBANKS MEMORIAL CARDIOLOGY CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FOUNDATION HEALTH LLC",
        "enumeration_date": "2016-09-29",
        "last_updated": "2026-04-14",
        "certification_date": "2026-04-14",
        "status": "A",
        "authorized_official_last_name": "SUDUTH",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "907-458-3310",
        "authorized_official_credential": "CPA, FHFMA, FACHE"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1656021",
            "state": "AK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmdprod.craneware.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Serivce",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.17.9.1",
            "affiliationName": "Craneware, Inc",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "3340 Peachtree Rd NE Ste 850",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303261072",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2026; 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.