Interior Community Health Center

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

INTERIOR COMMUNITY HEALTH CENTER

Practice address

1606 23Rd Ave
Fairbanks, AK 99701-6407

Phone

(907) 455-4567

Fax

(907) 458-1589

NPI assigned

May 31, 2007

Organization subpart

No

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

Authorized official

Name

Cheryl Kilgore

Title

Executive Director

Phone

(907) 455-4567

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AK2 enrollments

Enrollment records 2

Federally qualified health center certification: CCN 021810

Legal name

INTERIOR COMMUNITY HEALTH CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Sep 18, 1995

Last certification

Sep 18, 1995

Ownership / control type

For profit – partnership

Organization structure

CorporationNon-profit

Incorporated

May 17, 1993 in AK

Enrollment address

1606 23Rd Ave
Fairbanks, AK 99701-6407

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Interior Community Health Center

  • Primary Care Clinic/Center
  • Healy, AK
  • NPI 1609942754

  9830001031

  Same PAC ID

Other NPIs on the same Medicare enrollment 3

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

• Interior Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Fairbanks, AK
  • NPI 1588739015

  O20031105000421

  Same enrollment
• Interior Community Health Center

  • Primary Care Clinic/Center
  • Healy, AK
  • NPI 1609942754

  O20031105000421

  Same enrollment
• Interior Community Health Center Dental Prog

  • Dental Clinic/Center
  • Fairbanks, AK
  • NPI 1124244181

  O20031105000421

  Same enrollment

All disclosed owners & managing parties 11

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

Practitioners 4

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

• Ashley L Franklin, MD

  • Family Medicine Physician
  • Anchorage, AK
  • NPI 1093242497
  NPD (past)
• Christy Lee Smith, MS, LPCS, BHP

  • Community Health Worker
  • Fairbanks, AK
  • NPI 1477831584
  NPD (past)
• Rebecca Virginia Taylor, D.O.

  • Family Medicine Physician
  • Anchorage, AK
  • NPI 1821438417
  NPD (past)
• Zachary Tye Taylor, PA

  • Physician Assistant
  • Fairbanks, AK
  • NPI 1306667746
  NPD (past)

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217808000000",
    "number": "1457552903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1606 23RD AVE",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997016407",
            "telephone_number": "907-455-4567",
            "fax_number": "907-458-1589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1606 23RD AVE",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997016407",
            "telephone_number": "907-455-4567",
            "fax_number": "907-458-1589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERIOR COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2008-08-04",
        "status": "A",
        "authorized_official_last_name": "KILGORE",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "907-455-4567"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "02D0876889",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "02D0902300",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Interior AIDS Association
• Interior AIDS Association
• Interior Alaska DBT & Counseling, LLC
• Interior Alaska Orthopedic & Sports Medicine Inc
• Interior Birthing Center LLC
• Interior Community Health Center
• Interior Community Health Center Dental Prog
• Interior Eye Center, LLC
• Interior Medical Supply LLC
• Interior Mobility Systems LLC

• Federally Qualified Health Center (FQHC) in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Federally Qualified Health Center (FQHC) in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.