Southcentral Foundation

Primary specialty

Community Health Clinic/CenterTaxonomy code 261QC1500X

Legal business name

SOUTHCENTRAL FOUNDATION

Doing business as

Tribal- Eklutna Community Clinic

Practice address

26341 Eklutna Village Rd
Chugiak, AK 99567-5148

Phone

(907) 688-6031

NPI assigned

Sep 14, 2018

Organization subpart

Yes

Parent organization

SOUTHCENTRAL FOUNDATIONAs reported in NPPES

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

Authorized official

Name

Ronald Lee Olson

Title

Executive Vice President Finance

Phone

(907) 729-4939

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Tribal- Eklutna Community Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Part of

Anchorage Primary Care Clinic

Locations

Practitioners 4

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

• Jessica Ellen Bury, M.D.

  • Obstetrics & Gynecology Physician
  • Anchorage, AK
  • NPI 1396061149
  NPD
• Sarah Ferroni, FNP

  • Family Nurse Practitioner
  • Sutton, AK
  • NPI 1679081889
  NPD
• Allison Michelle Hillen, MS, RDN

  • Registered Dietitian
  • Wasilla, AK
  • NPI 1356964662
  NPD
• Ashley L Voigt, CPNP, RN

  • Pediatric Nurse Practitioner
  • Anchorage, AK
  • NPI 1215292909
  NPD

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

{
    "created_epoch": "1536883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696896000000",
    "number": "1639652662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35198",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981245198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26341 EKLUTNA VILLAGE RD",
            "city": "CHUGIAK",
            "state": "AK",
            "postal_code": "995675148",
            "telephone_number": "907-688-6031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHCENTRAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHCENTRAL FOUNDATION",
        "enumeration_date": "2018-09-14",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT FINANCE",
        "authorized_official_telephone_number": "907-729-4939"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1687933",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tribal- Eklutna Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Zulene O. Simmons, ANP
• Shakeria Lashawnda Smith, LMT
• Natalie Snyder, DPT
• Southcentral Foundation
• Southcentral Foundation
• Mariah Spear, OTR/L
• Caleb Stepp, MS, CDC II, BHC II
• Therapeutic Health and Home LLC
• Jasmine Titcomb, OTR/L
• Chelsea Vadnais, OTR/L

• Community Health Clinic/Center in Chugiak, AK
• Providers in Chugiak, AK by specialty
• Community Health Clinic/Center in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2023; 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.