NPIMap

Organization Active NPI

Ninilchik Village

  • Community Health Clinic/Center
  • Ninilchik, AK
National Provider Identifier
1609093723
Registry record updated Oct 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
License
296082 Issued in AK
Legal business name
NINILCHIK VILLAGE
Practice address
15765 Kingsley Road
Ninilchik, AK 99639-9759
Phone
(907) 567-3970
Fax
(907) 567-3948
NPI assigned
Apr 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2025

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

Authorized official

Name
Mr. Ivan Zane Encelewski
Title
Executive Director
Phone
(907) 567-3313

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X 296082 AK Primary

Addresses

Primary practice location

15765 Kingsley Road
Ninilchik, AK 99639-9759

Mailing address

PO Box 39368
Ninilchik, AK 99639-0368
Phone (907) 567-3970

Other identifiers 1

IdentifierTypeStateIssuer
CL 2699MedicaidAK

Other names 2

  • NTC Community Clinic Doing business as
  • Ninilchik Community Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110727000248 AK Part B Supplier - Clinic/Group Practice 9638347149 Receives reassigned benefits from 12 practitioners
Practice locations: Ninilchik, AK

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
02D0641001Ninilchik Community Clinic15765 Kingsley Road, Ninilchik, AK 99639Provider-performed microscopySep 21, 2027

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: sarahspencer@ncc.allscriptsdirect.net
  • Direct secure messaging: tamarmarcotte@ncc.allscriptsdirect.net
  • Direct secure messaging: kristinafinkenbinder@ncc.allscriptsdirect.net

Practitioners & affiliated clinicians

Practitioners 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760486400000",
    "number": "1609093723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 39368",
            "city": "NINILCHIK",
            "state": "AK",
            "postal_code": "996390368",
            "telephone_number": "907-567-3970",
            "fax_number": "833-438-1910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15765 KINGSLEY ROAD",
            "city": "NINILCHIK",
            "state": "AK",
            "postal_code": "996399759",
            "telephone_number": "907-567-3970",
            "fax_number": "907-567-3948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NINILCHIK VILLAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2025-10-15",
        "certification_date": "2025-10-15",
        "status": "A",
        "authorized_official_last_name": "ENCELEWSKI",
        "authorized_official_first_name": "IVAN",
        "authorized_official_middle_name": "ZANE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "907-567-3313",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "AK",
            "license": "296082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CL 2699",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NTC Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ninilchik Community Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Ninilchik Community Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ninilchik, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.