Peacehealth

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

NO NUMBERS ISSUED Issued in AK

Legal business name

PEACEHEALTH

Practice address

3100 Tongass Ave
Ketchikan, AK 99901-5746

Phone

(907) 228-8300

Fax

(907) 228-8518

NPI assigned

Nov 7, 2006

Organization subpart

No

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

• Peacehealth

  • Medicare Defined Swing Bed Hospital Unit
  • Ketchikan, AK
  • NPI 1528544822

  5% Or Greater Direct Ownership Interest

  CMS ownership
• Peacehealth

  • Skilled Nursing Facility
  • Ketchikan, AK
  • NPI 1851336176

  5% Or Greater Direct Ownership Interest, Operational/Managerial Control

  CMS ownership

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

• Peacehealth

  • Critical Access Hospital
  • Ketchikan, AK
  • NPI 1396705539

  9436067618

  Same PAC ID
• Peacehealth

  • Medicare Defined Swing Bed Hospital Unit
  • Ketchikan, AK
  • NPI 1528544822

  9436067618

  Same PAC ID
• Peacehealth

  • Home Health Agency
  • Ketchikan, AK
  • NPI 1760427082

  9436067618

  Same PAC ID
• Peacehealth

  • Skilled Nursing Facility
  • Ketchikan, AK
  • NPI 1851336176

  9436067618

  Same PAC ID

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

• Victor Chen, M.D.

  • Psychiatry Physician
  • Ketchikan, AK
  • NPI 1447562921

  AK, Psychiatry

  Medicare reassignment Care Compare group NPD
• Alan L Christensen, M.D.

  • Obstetrics & Gynecology Physician
  • Ketchikan, AK
  • NPI 1194720250

  AK, Obstetrics & Gynecology

  Medicare reassignment Care Compare group NPD
• Ian Dobbe

  • Hospitalist Physician
  • Ketchikan, AK
  • NPI 1710337381

  AK, Family Medicine

  Medicare reassignment Care Compare group NPD
• Charles Go Jose, MD, MPH

  • Family Medicine Physician
  • Ketchikan, AK
  • NPI 1881125938

  AK, Family Medicine

  Medicare reassignment Care Compare group NPD
• Sarah Katchen, MD

  • Surgery Physician
  • Ketchikan, AK
  • NPI 1922560887

  AK, Surgery

  Medicare reassignment Care Compare group NPD
• Christy Le, MD

  • Anesthesiology Physician
  • Anchorage, AK
  • NPI 1508206459

  AK, Single Specialty

  Medicare reassignment Care Compare group NPD
• Joseph Charles Livengood, M.D.

  • Surgery Physician
  • Fairbanks, AK
  • NPI 1518948447

  AK, Surgery

  Medicare reassignment Care Compare group NPD
• Gabriella Madsen, MSN, RN, FNP-C

  • Family Nurse Practitioner
  • Ketchikan, AK
  • NPI 1013775410

  AK

  Medicare reassignment Care Compare group NPD
• Kevin Michael Maguire, M.D.

  • Anesthesiology Physician
  • Ketchikan, AK
  • NPI 1144256132

  AK, Anesthesiology

  Medicare reassignment Care Compare group NPD
• Jon L Miller, MD

  • Family Medicine Physician
  • Ketchikan, AK
  • NPI 1700453784

  AK, Family Medicine

  Medicare reassignment Care Compare group NPD
• Andrew D Pankow, MD

  • Family Medicine Physician
  • Ketchikan, AK
  • NPI 1790711992

  AK, Family Medicine

  Medicare reassignment Care Compare group NPD
• Peter E Rice, MD

  • Internal Medicine Physician
  • Ketchikan, AK
  • NPI 1548291396

  AK, Internal Medicine

  Medicare reassignment Care Compare group NPD

Medicare fee-for-service enrollment

Enrolled in AK, NY, TX, IA, GA, OR, NC, NM, IN, FL, CO, PA, TN, OH, CA, VA16 enrollments

Enrollment records 16

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Peacehealth

  • Community Based Hospice Care Agency
  • Ketchikan, AK
  • NPI 1386362580

  Member Of

  NPD member

Locations

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

Authorized official

Name

Patrick J Branco

Title

Ceo

Phone

(907) 228-8300

Specialties & licenses 14

Addresses

Other identifiers 3

Other names 1

• KETCHIKAN MEDICAL CENTER Doing business as

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314748800000",
    "number": "1801965736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1798",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982271798",
            "telephone_number": "360-734-5400",
            "fax_number": "360-715-6552"
        },
        {
            "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": "907-228-8300",
            "fax_number": "907-228-8518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACEHEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2011-08-31",
        "status": "A",
        "authorized_official_last_name": "BRANCO",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "907-228-8300"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Midwife",
            "state": "AK",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": "AK",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "AK",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "AK",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "AK",
            "license": null,
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "AK",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "AK",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "AK",
            "license": "NO NUMBERS ISSUED",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "AK",
            "license": "NO NUMBERS ISSUED",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "AK",
            "license": "NO NUMBERS ISSUED",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AK",
            "license": "NO NUMBERS ISSUED",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AK",
            "license": "NO NUMBERS ISSUED",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "AK",
            "license": "NO NUMBERS ISSUED",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AK",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HOSPITAL PRO#",
            "identifier": "6110165",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA CLINIC PRO#",
            "identifier": "7695464",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MDG235",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KETCHIKAN MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Peacehealth
• Peacehealth
• Peacehealth
• Peacehealth
• Peacehealth
• Peacehealth
• Jessica Peavy, CT
• Clarence Peele
• Crystal Pennino, NP-C
• Ricki Perro

• All providers in Ketchikan, AK
• Diagnostic Radiology Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.