NPIMap

Organization Active NPI

Chugachmiut

  • Community Health Clinic/Center
  • Tatitlek, AK
National Provider Identifier
1801067723
Registry record updated Sep 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
CHUGACHMIUT
Practice address
505 Copper Mountain Street
Tatitlek, AK 99677
Phone
(907) 325-2235
Fax
(907) 325-2350
NPI assigned
Mar 19, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2022

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

Authorized official

Name
Kelley Baker
Title
Health Services Division Director
Phone
(907) 562-4155

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

505 Copper Mountain Street
Tatitlek, AK 99677

Mailing address

1840 Bragaw St Ste 110
Anchorage, AK 99508-3463
Phone (907) 562-4155

Other identifiers 1

IdentifierTypeStateIssuer
1021383MedicaidAK

Other names 1

  • Tatitlek Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK, TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040323001690 AK Part B Supplier - Clinic/Group Practice 0648161141 Receives reassigned benefits from 9 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chenega Bay, AK; Tatitlek, AK; Seward, AK; Nanwalek, AK; Port Graham, AK
O20250516003075 TX Part B Supplier - Clinic/Group Practice 0648161141 Receives reassigned benefits from 3 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Anchorage, AK; Chenega, AK; Nanwalek, AK; Port Graham, AK; Seward, AK; Tatitlek, AK

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Chugachmiut8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1205884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663804800000",
    "number": "1801067723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1840 BRAGAW ST STE 110",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995083463",
            "telephone_number": "907-562-4155",
            "fax_number": "907-563-2891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 COPPER MOUNTAIN STREET",
            "city": "TATITLEK",
            "state": "AK",
            "postal_code": "99677",
            "telephone_number": "907-325-2235",
            "fax_number": "907-325-2350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHUGACHMIUT",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-19",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-19",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_title_or_position": "HEALTH SERVICES DIVISION DIRECTOR",
        "authorized_official_telephone_number": "907-562-4155"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1021383",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tatitlek Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tatitlek Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tatitlek, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.