NPIMap

Organization Active NPI

Peninsula Community Health Services of Alaska, Inc.

  • Federally Qualified Health Center (FQHC)
  • Soldotna, AK
National Provider Identifier
1700984614
Registry record updated Jul 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC.
Practice address
230 E Marydale Ave
Soldotna, AK 99669-7648
Phone
(907) 260-7300
Fax
(907) 260-7301
NPI assigned
Sep 21, 2006
Last updated
Jul 17, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2026

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

Authorized official

Name
Benjamin J Wright
Title
Ceo
Phone
(907) 260-7314

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

230 E Marydale Ave
Soldotna, AK 99669-7648

Mailing address

PO Box 2949
Soldotna, AK 99669-2949
Phone (907) 260-7300

Other practice location 1

395 Main Street Loop
Kenai, AK 99611-7727
Phone (907) 283-7759

Other practice location 2

290 Arbor Ave
Soldotna, AK 99669-7664
Phone (907) 262-3119

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040415000965 AK Part B Supplier - Clinic/Group Practice 8426043894 Receives reassigned benefits from 23 practitioners
1 other NPI on this enrollment
Practice locations: Kenai, AK; Soldotna, AK
O20090318000159 AK Part A Provider - Federally Qualified Health Center (FQHC) 8426043894 Practice locations: Soldotna, AK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700984614. Details of each certification follow.

Federally qualified health center certification: CCN 021819

Legal name
PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 1, 2002
Last certification
Sep 1, 2002
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 24, 2001 in AK
Enrollment address
230 E Marydale Ave
Soldotna, AK 99669-7648

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

395 Main Street Loop
Kenai, AK 99611
Phone (907) 283-7759

805 Frontage Rd
Kenai, AK 99611
Phone (907) 262-3119

805 Frontage Rd
Ste 130
Kenai, AK 99611
Phone (907) 283-2231

230 E Marydale Ave
Ste 1
Soldotna, AK 99669
Phone (907) 262-3119

230 E Marydale Ave
Ste 3
Soldotna, AK 99669
Phone (907) 260-7300

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Diane Fielden Individual Corporate Director Mar 1, 2015
Lance Spindler Individual Corporate DirectorDirector Feb 2, 2026
Kelly Martin Individual Corporate DirectorDirector Sep 1, 2019
Kevin Lundeberg Individual Corporate DirectorDirector Oct 2, 2023
Patricia Merwin Individual Corporate DirectorDirector Feb 6, 2023
Mitch Michaud Individual Corporate DirectorDirector Feb 1, 2010
Heather L Callum Individual Corporate DirectorDirector Feb 3, 2025
Cris Lee Individual W-2 Managing EmployeeChief Operations Officer Nov 1, 2022
Benjamin Wright Individual Corporate OfficerChief Executive Officer May 13, 2019
W-2 Managing Employee May 13, 2019
Annette Villa Individual Corporate DirectorDirector Jul 7, 2025
Charlene Tautfest Individual Corporate DirectorDirector Jul 1, 2017
Romi Haseo Individual Corporate DirectorDirector Dec 2, 2019
Marvin St Clair Individual Corporate DirectorDirector Jul 7, 2025
Ted Wellman Individual Corporate DirectorDirector Jul 1, 2017
Donna Cotman Individual Corporate DirectorDirector Apr 4, 2022
Lisa Roberts Individual Corporate DirectorDirector Apr 4, 2022

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Peninsula Community Health Services of Alaska IncKenai, AK, CCN 021849 Federally qualified health center Operational/Managerial Control Dec 1, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 69

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 69

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784246400000",
    "number": "1700984614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2949",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996692949",
            "telephone_number": "907-260-7300",
            "fax_number": "907-260-7301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 E MARYDALE AVE",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996697648",
            "telephone_number": "907-260-7300",
            "fax_number": "907-260-7301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "395 Main Street Loop",
            "address_purpose": "LOCATION",
            "city": "Kenai",
            "state": "AK",
            "postal_code": "996117727",
            "country_code": "US",
            "telephone_number": "907-283-7759",
            "fax_number": "907-283-4883",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "290 Arbor Ave",
            "address_purpose": "LOCATION",
            "city": "Soldotna",
            "state": "AK",
            "postal_code": "996697664",
            "country_code": "US",
            "telephone_number": "907-262-3119",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2026-07-17",
        "certification_date": "2026-07-17",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "907-260-7314"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Soldotna, AK

Sources for this page

Verify at the official NPI Registry.