Active NPI
Renee Rose Kimaktoak, CHA-T
- Community Health Worker
- Nome, AK
National Provider Identifier
1609498484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 1000 Greg Krushek Ave
Nome, AK 99762-0966 - Phone
- (907) 624-3535
- Fax
- (907) 624-3692
- NPI assigned
- May 14, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | AK | Primary |
Addresses
Primary practice location
1000 Greg Krushek Ave
Nome, AK 99762-0966
Mailing address
PO Box 189
Unalakleet, AK 99684-0189
Phone (907) 624-3535
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CHA-T | Other | AK | CHA-T |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | CHA-T | Other |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Norton Sound Health Corporation | Past | Accepting new patients | |
| NSHC Unalakleet Subregional Clinic | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Unalakleet, AK
- NPI 1245605179
-
- Rural Acute Care Hospital
- Unalakleet, AK
- NPI 1255585360
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1589414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589414400000",
"number": "1609498484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 189",
"city": "UNALAKLEET",
"state": "AK",
"postal_code": "996840189",
"telephone_number": "907-624-3535",
"fax_number": "907-624-3692"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 GREG KRUSHEK AVE",
"city": "NOME",
"state": "AK",
"postal_code": "997620966",
"telephone_number": "907-624-3535",
"fax_number": "907-624-3692"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMAKTOAK",
"first_name": "RENEE",
"middle_name": "ROSE",
"credential": "CHA-T",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-05-14",
"last_updated": "2020-05-14",
"certification_date": "2020-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "AK",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHA-T",
"identifier": "CHA-T",
"state": "AK"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "CHA-T",
"affiliation": "N",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CHA-T",
"address_1": "1000 Greg Krushek Ave",
"city": "Nome",
"state": "AK",
"country_code": "US",
"postal_code": "997620966",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Nome, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.