NPIMap

Organization Active NPI

Fairbanks Memorial Hospital, LLC

  • General Acute Care Hospital
  • Fairbanks, AK
National Provider Identifier
1720537178
Registry record updated Oct 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
FAIRBANKS MEMORIAL HOSPITAL, LLC
Practice address
1650 Cowles St
Fairbanks, AK 99701-5907
Phone
(907) 458-5525
NPI assigned
Sep 27, 2016
Organization subpart
Yes
Parent organization
FOUNDATION HEALTH, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 2, 2023

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

Authorized official

Name
Anthony G Sudduth, CPA, FHFMA, FACHE
Title
Cfo
Phone
(907) 458-5300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X AK Primary

Addresses

Primary practice location

1650 Cowles St
Fairbanks, AK 99701-5907

Mailing address

1650 Cowles St
Fairbanks, AK 99701-5907
Phone (949) 774-2375

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmdprod.craneware.com:8291/Gateway/DoumentSubmission/2_0/NhinService/XDRRequ4est_Service Other Craneware, Inc

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170104000150 AK Part A Provider - Hospital 2961783048 Practice locations: Fairbanks, AK

Hospital certification: CCN 020012

Legal name
FAIRBANKS MEMORIAL HOSPITAL LLC
Doing business as
FAIRBANKS MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1968
Last certification
Apr 6, 2018
Beds
162
Ownership / control type
Private (not for profit)
Most recent change of ownership
Jan 1, 2017 (1 total)
Organization structure
LLCNon-profit
Enrollment address
1650 Cowles St
Fairbanks, AK 99701-5907
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Fairbanks Memorial HospitalCCN 020012
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Fairbanks Memorial Hospital LLC7 organizations share this tax ID, including this one
Part of
Foundation Health LLC

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1701 Gillam Way
Ste A
Fairbanks, AK 99701
Phone (907) 458-5678

2111 Cowles St
Fairbanks, AK 99701
Phone (907) 457-4900

1919 Lathrop St
Ste 207
Fairbanks, AK 99701
Phone (907) 456-7768

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Greater Fairbanks Community Hospital Foundation Inc Organization, Fairbanks, AK LLC, Non-profit 5% Or Greater Indirect Ownership Interest Dec 22, 2022 100%
Shelley D Ebenal Individual Corporate OfficerChief Executive Officer Feb 24, 2019 100%
W-2 Managing EmployeeChief Executive Officer Feb 24, 2019 100%
Operational/Managerial ControlChief Executive Officer Feb 24, 2019 100%
Sarah Martin Individual W-2 Managing EmployeeCno Jan 1, 2017 100%
Operational/Managerial ControlCno Jan 1, 2017 100%
Anthony G Sudduth Individual Corporate OfficerCfo Jul 24, 2023 100%
Corporate DirectorCfo Jul 24, 2023
W-2 Managing EmployeeCfo Jul 24, 2023 100%
Karen Ruth Perdue Individual Corporate OfficerBoard Secretary Nov 1, 2022 100%
Corporate DirectorBoard Secretary Jan 1, 2017 100%
Scott Bell Individual Corporate OfficerPresident Nov 1, 2022 100%
Corporate DirectorBoard of Directors Jan 1, 2013 100%
Steve Frank Individual Corporate OfficerTreasurer Nov 1, 2022 100%
Corporate DirectorBoard of Directors Jan 1, 2019 100%
Joseph Faulhaber Individual Corporate OfficerVice President Jan 1, 2017 100%
Corporate DirectorMember Board of Directors Jan 1, 2017 100%
Foundation Health LLC Organization, Fairbanks, AK LLC, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2017 100%

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 62

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

View all 62

Affiliated clinicians 382

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 382

NPI Registry JSON

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

{
    "created_epoch": "1474934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696204800000",
    "number": "1720537178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 COWLES ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015907",
            "telephone_number": "949-774-2375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 COWLES ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015907",
            "telephone_number": "907-458-5525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRBANKS MEMORIAL HOSPITAL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FOUNDATION HEALTH, LLC",
        "enumeration_date": "2016-09-27",
        "last_updated": "2023-10-02",
        "certification_date": "2023-10-02",
        "status": "A",
        "authorized_official_last_name": "SUDDUTH",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "907-458-5300",
        "authorized_official_credential": "CPA, FHFMA, FACHE"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "AK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmdprod.craneware.com:8291/Gateway/DoumentSubmission/2_0/NhinService/XDRRequ4est_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.17.9.1",
            "affiliationName": "Craneware, Inc",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "3340 Peachtree Rd NE Ste 850",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303261072",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

Verify at the official NPI Registry.