NPIMap

Organization Active NPI

Central Peninsula General Hospital Inc

Doing business as Central Peninsula Family Practice

  • Rural Acute Care Hospital
  • Kenai, AK
National Provider Identifier
1770723967
Registry record updated Dec 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Acute Care HospitalTaxonomy code 282NR1301X
License
926294 Issued in AK
Legal business name
CENTRAL PENINSULA GENERAL HOSPITAL INC
Doing business as
Central Peninsula Family Practice
Practice address
506 Lake St
Kenai, AK 99611-6937
Phone
(907) 714-4030
Fax
(907) 335-0064
NPI assigned
Feb 27, 2009
Last updated
Dec 7, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2020

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

Authorized official

Name
Richard Davis
Title
Ceo
Phone
(907) 714-4723

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Acute Care Hospital 282NR1301X 926294 AK Primary
Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363A00000X 926294 AK
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X 926294 AK

Addresses

Primary practice location

506 Lake St
Kenai, AK 99611-6937

Mailing address

506 Lake St
Kenai, AK 99611-6937
Phone (907) 714-4030

Other names 1

  • Central Peninsula Family Practice Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cc_acp_cp_fp_kenai_clinical_support_staff1225778@ak.providencedirect.org

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040310000598 AK Part B Supplier - Clinic/Group Practice 4587552575 Receives reassigned benefits from 136 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Soldotna, AK; Kenai, AK
O20050609000176 AK Part A Provider - Hospital 4587552575 18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Soldotna, AK; Kenai, AK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770723967. Details of each certification follow.

Hospital certification: CCN 020024

Legal name
CENTRAL PENINSULA GENERAL HOSPITAL INC
Doing business as
CENTRAL PENINSULA GENERAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Aug 5, 1971
Last certification
Aug 3, 2006
Beds
49
Ownership / control type
Other
Organization structure
CorporationProprietary
Incorporated
Jan 1, 1993 in AK
Enrollment address
250 Hospital PL
Soldotna, AK 99669-7559
Hospital subgroups
Acute care

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

Other NPIs on the same Medicare enrollment 20

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

View all 20

Care Compare: Hospital

Medicare Care Compare
Listed as
Central Peninsula General HospitalCCN 020024 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Other
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
02D1005759Central Peninsula Family Practice-Kenai506 Lake Street, Kenai, AK 99611Certificate of waiverSep 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
Cntrl Peninsula Gen Hos18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Locations

506 Lake St
Kenai, AK 99611
Phone (907) 714-4025

245 N Binkley St
Soldotna, AK 99669
Phone (907) 714-4111

Interoperability endpoints

  • Direct secure messaging: cc_acp_cp_fp_kenai_clinical_support_staff1225778@ak.providencedirect.org

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
Carrie Couey Individual Corporate DirectorBoard of Directors Jan 1, 2020
Shaun Patrick Keef Individual Corporate OfficerCeo Jan 11, 2019
W-2 Managing EmployeeCeo Jan 11, 2019
Michael Reyes Individual Corporate DirectorBoard of Directors Jan 1, 2023
Paul Ostrander Individual Corporate DirectorBoard of Directors Jan 1, 2022
Karl Hertz Individual Corporate OfficerCoo Jun 16, 2025
Central Peninsula General Hospital Inc Organization, Soldotna, AK Non-profit Operational/Managerial Control Nov 26, 2007
Trena Richardson Individual Corporate DirectorBoard of Directors Jan 1, 2020
Jay S Rohloff Individual Corporate DirectorBoard of Directors Jan 1, 2021
Jesse J Kincaid Individual Corporate DirectorBoard of Directors Jan 1, 2022
Shanda Rochelle Richards Individual W-2 Managing EmployeeRevenue Cycle Director Feb 8, 2021
Bradley T Cross Individual Corporate DirectorBoard of Directors Jan 1, 2023
Max Best Individual Corporate DirectorBoard of Directors Jan 1, 2021
Stephanie Queen Individual Corporate DirectorBoard of Directors Jan 1, 2023
Angela Hinnegan Individual Corporate OfficerCfo Aug 1, 2025
Barb Belloumini Individual Corporate Director Jan 1, 2025
Silverio Mattero Individual Corporate DirectorBoard of Directors Jan 1, 2022

Owners & managing parties with NPI records 7

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

Practitioners & affiliated clinicians

Practitioners 16

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 16

Affiliated clinicians 387

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

View all 387

NPI Registry JSON

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

{
    "created_epoch": "1235692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607299200000",
    "number": "1770723967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 LAKE ST",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "996116937",
            "telephone_number": "907-714-4030",
            "fax_number": "907-335-0064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 LAKE ST",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "996116937",
            "telephone_number": "907-714-4030",
            "fax_number": "907-335-0064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL PENINSULA GENERAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-27",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "907-714-4723"
    },
    "taxonomies": [
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "AK",
            "license": "926294",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "926294",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "AK",
            "license": "926294",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cc_acp_cp_fp_kenai_clinical_support_staff1225778@ak.providencedirect.org",
            "affiliation": "N",
            "endpointDescription": "Central Peninsula Family Practice Clinical Support Staff",
            "address_1": "506 Lake St",
            "city": "Kenai",
            "state": "AK",
            "country_code": "US",
            "postal_code": "996116937",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Central Peninsula Family Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Central Peninsula Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kenai, AK

Sources for this page

Verify at the official NPI Registry.