NPIMap

Organization Active NPI

Bristol Bay Area Health Corporation

  • Medicare Defined Swing Bed Hospital Unit
  • Dillingham, AK
National Provider Identifier
1770645202
Registry record updated Apr 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
BRISTOL BAY AREA HEALTH CORPORATION
Practice address
6000 Kanakanak Rd
Dillingham, AK 99576-0130
Phone
(907) 842-5201
Fax
(907) 842-9250
NPI assigned
Dec 14, 2006
Last updated
Apr 4, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2013

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

Authorized official

Name
Mr. Robert Clark
Title
Ceo
Phone
(907) 842-5201

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

Addresses

Primary practice location

6000 Kanakanak Rd
Dillingham, AK 99576-0130

Mailing address

PO Box 130
Dillingham, AK 99576-0130
Phone (907) 842-5201

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031120000998 TX Part B Supplier - Clinic/Group Practice 5890699920 Receives reassigned benefits from 432 practitioners
44 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lebelock, AK; Manokotak, AK; Goodnews Bay, AK; Naknek, AK; New Stuyahok, AK; Perryville, AK; Pilot Point, AK; Platinum, AK…
O20220721002167 AK Part A Provider - Critical Access Hospital 5890699920 Practice locations: Dillingham, AK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770645202. Details of each certification follow.

Hospital certification: CCN 02Z309

Legal name
BRISTOL BAY AREA HEALTH CORPORATION
Doing business as
KANAKANAK HOSPITAL
Organization structure
OtherNon-profit
Incorporated
Jul 10, 1973 in AK
Enrollment address
6000 Kanakanak Rd
Dillingham, AK 99576-0130
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 38

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

View all 38

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: aahorstman@direct.bbahc.org
  • Direct secure messaging: ajcolton@direct.bbahc.org
  • Direct secure messaging: albennett@direct.bbahc.org
  • Direct secure messaging: alwoelk@direct.bbahc.org
  • Direct secure messaging: apliewen@direct.bbahc.org
  • Direct secure messaging: begottfredson@direct.bbahc.org
  • Direct secure messaging: blriley@direct.bbahc.org
  • Direct secure messaging: cltunney@direct.bbahc.org
  • Direct secure messaging: cmbritt@direct.anthc.org
  • Direct secure messaging: cmlink@direct.bbahc.org
  • Direct secure messaging: cmstordeur@direct.bbahc.org
  • Direct secure messaging: dapetteway@direct.bbahc.org
  • Direct secure messaging: djbowers@direct.bbahc.org
  • Direct secure messaging: djpowers@direct.bbahc.org
  • Direct secure messaging: epdavis@direct.bbahc.org
  • Direct secure messaging: epoliver@direct.bbahc.org
  • Direct secure messaging: ersnyder@direct.bbahc.org
  • Direct secure messaging: gcwaite@direct.bbahc.org
  • Direct secure messaging: jalynch@direct.bbahc.org
  • Direct secure messaging: jastalmaster@direct.bbahc.org

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Nathaniel Hall Individual W-2 Managing EmployeeChief Human Resources Officer Mar 30, 2020 5%
Bristol Bay Area Health Corporation Organization, Dillingham, AK Corporation 5% Or Greater Direct Ownership Interest Oct 14, 2011 100%
Robert Clark Individual Corporate DirectorCeo/President Oct 25, 2004

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Kanakanak HospitalDillingham, AK, CCN 021309 Hospital 5% Or Greater Direct Ownership Interest (100%) Oct 14, 2011

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 346

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 346

Affiliated clinicians 1

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

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365033600000",
    "number": "1770645202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "DILLINGHAM",
            "state": "AK",
            "postal_code": "995760130",
            "telephone_number": "907-842-5201",
            "fax_number": "907-842-9250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 KANAKANAK RD",
            "city": "DILLINGHAM",
            "state": "AK",
            "postal_code": "995760130",
            "telephone_number": "907-842-5201",
            "fax_number": "907-842-9250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRISTOL BAY AREA HEALTH CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2013-04-04",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "907-842-5201",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dillingham, AK

Sources for this page

Verify at the official NPI Registry.