NPIMap

Organization Active NPI

Southcentral Foundation

Doing business as BSD - McGrath

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • McGrath, AK
National Provider Identifier
1780614263
Registry record updated Sep 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
20467 Issued in AK
Legal business name
SOUTHCENTRAL FOUNDATION
Doing business as
BSD - McGrath
Practice address
10 DNR Road
McGrath, AK 99627
Phone
(907) 524-3299
NPI assigned
Jul 3, 2006
Last updated
Sep 15, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHCENTRAL FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 15, 2023

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

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 20467 AK Primary

Addresses

Primary practice location

10 DNR Road
McGrath, AK 99627

Mailing address

PO Box 35198
Seattle, WA 98124-5198

Other identifiers 2

IdentifierTypeStateIssuer
1000855MedicaidAK
1021095MedicaidAK

Other names 1

  • BSD - McGrath Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051027000416 TX Part B Supplier - Clinic/Group Practice 5496663627 Receives reassigned benefits from 534 practitioners
Practice locations: Anchorage, AK; Chugiak, AK; Fairbanks, AK; Igiugig, AK; Iliamna, AK; Kockhanok, AK; McGrath, AK; Nondalton, AK…

National Provider Directory

National Provider Directory
Part of
Southcentral Foundation Nikolai Health Center

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Alaska Native Medical CenterAnchorage, AK, CCN 020026 Hospital Other Jan 1, 1999

Owned or controlled facilities with NPI records 13

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

View all 13

Practitioners & affiliated clinicians

Practitioners 567

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 567

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694736000000",
    "number": "1780614263",
    "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": "10 DNR ROAD",
            "city": "MCGRATH",
            "state": "AK",
            "postal_code": "99627",
            "telephone_number": "907-524-3299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHCENTRAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHCENTRAL FOUNDATION",
        "enumeration_date": "2006-07-03",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-15",
        "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": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "AK",
            "license": "20467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000855",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1021095",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BSD - McGrath",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in McGrath, AK

Sources for this page

Verify at the official NPI Registry.