NPIMap

Organization Active NPI

Ketchikan Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Ketchikan, AK
National Provider Identifier
1801690854
Registry record updated Aug 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
KETCHIKAN EMERGENCY PHYSICIANS, LLC
Practice address
3100 Tongass Ave
Ketchikan, AK 99901-5746
Phone
(907) 225-5171
NPI assigned
Apr 1, 2025
Last updated
Aug 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2026

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

Authorized official

Name
Kim Larsen
Title
VP, Credentialing
Phone
(770) 874-5400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X Primary

Addresses

Primary practice location

3100 Tongass Ave
Ketchikan, AK 99901-5746

Mailing address

PO Box 40804
Belfast, ME 04915-1260
Phone (770) 874-5400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250623003452 AK Part B Supplier - Clinic/Group Practice 8820500135 Receives reassigned benefits from 23 practitioners
Practice locations: Ketchikan, AK

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1743465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786579200000",
    "number": "1801690854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40804",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049151260",
            "telephone_number": "770-874-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 TONGASS AVE",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999015746",
            "telephone_number": "907-225-5171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETCHIKAN EMERGENCY PHYSICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-01",
        "last_updated": "2026-08-13",
        "certification_date": "2026-08-13",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "VP, CREDENTIALING",
        "authorized_official_telephone_number": "770-874-5400"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ketchikan, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2026; 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.