Southcentral Foundation

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

20467 Issued in AK

Legal business name

SOUTHCENTRAL FOUNDATION

Practice address

755 A St
Anchorage, AK 99501-3625

Phone

(907) 272-1255

NPI assigned

May 18, 2016

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- The Covenant House Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Part of

Anchorage Primary Care Clinic

Locations

Practitioners 5

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

• Stephanie Killingsworth, FNP

  • Family Nurse Practitioner
  • Anchorage, AK
  • NPI 1629616487
  NPD
• Morgan Taylor Noad, PA

  • Medical Physician Assistant
  • Anchorage, AK
  • NPI 1649808221

  Single Specialty

  NPD
• Amber Rochelle Beardslee, D.P.T.

  • Orthopedic Physical Therapist
  • Shiprock, NM
  • NPI 1407089162
  NPD
• Karen Cheryl Nelson, PT, MS, MD

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Missoula, MT
  • NPI 1457381881
  NPD
• Ashley J Reeder, PA-C

  • Medical Physician Assistant
  • West Jordan, UT
  • NPI 1639218969
  NPD

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

{
    "created_epoch": "1463529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694649600000",
    "number": "1689021776",
    "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": "755 A ST",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995013625",
            "telephone_number": "907-272-1255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHCENTRAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHCENTRAL FOUNDATION",
        "enumeration_date": "2016-05-18",
        "last_updated": "2023-09-14",
        "certification_date": "2023-09-14",
        "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": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "AK",
            "license": "20467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1658963",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tribal- The Covenant House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Southcentral Foundation
• Southcentral Foundation
• Southcentral Foundation
• Southcentral Foundation
• Southcentral Foundation
• Southcentral Foundation
• Southcentral Foundation
• Southcentral Foundation
• Southcentral Foundation
• Southcentral Foundation

• All providers in Anchorage, AK
• Multi-Specialty Clinic/Center in Alaska

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