Peacehealth

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

NO NUMBERS ISSUED Issued in AK

Legal business name

PEACEHEALTH

Doing business as

Ketchikan Medical Center

Practice address

3100 Tongass Ave
Ketchikan, AK 99901-5746

Phone

(907) 228-8300

Fax

(907) 228-8518

NPI assigned

Nov 7, 2006

Last updated

Aug 31, 2011By the provider in NPPES

Organization subpart

No

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

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

Other NPIs with the same Medicare PAC ID 4

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

• Peacehealth

  dba Ketchikan Medical Center

  • Critical Access Hospital
  • Ketchikan, AK
  • NPI 1396705539

  9436067618

  Same PAC ID
• Peacehealth

  dba Ketchikan Medical Center

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

  9436067618

  Same PAC ID
• Peacehealth

  dba Ketchikan Medical Center Home Health

  • Home Health Agency
  • Ketchikan, AK
  • NPI 1760427082

  9436067618

  Same PAC ID
• Peacehealth

  dba Ketchikan Gen Hosp LTC

  • Skilled Nursing Facility
  • Ketchikan, AK
  • NPI 1851336176

  9436067618

  Same PAC ID

Member of 1

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

• Peacehealth

  • Radiology Clinic/Center
  • Kelso, WA
  • NPI 1831800184

  Member Of

  NPD member

Locations

All facility ownership & control disclosures 2

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

Owned or controlled facilities with NPI records 2

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

• Peacehealth

  dba Ketchikan Medical Center

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

  5% Or Greater Direct Ownership Interest

  CMS ownership
• Peacehealth

  dba Ketchikan Gen Hosp LTC

  • Skilled Nursing Facility
  • Ketchikan, AK
  • NPI 1851336176

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

  CMS ownership

Practitioners 165

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.

• Christy Le, MD

  • Anesthesiology Physician
  • Anchorage, AK
  • NPI 1508206459

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Anna Whitney Anderson, MD

  • Diagnostic Radiology Physician
  • Seattle, WA
  • NPI 1083110746

  AK

  Medicare reassignment Care Compare group NPD
• Laura Backer, MD

  • Diagnostic Radiology Physician
  • Bellingham, WA
  • NPI 1548266877

  AK

  Medicare reassignment Care Compare group NPD
• Peter Alan Beglin, M.D.

  • Interventional Cardiology Physician
  • Bellingham, WA
  • NPI 1154370906

  AK

  Medicare reassignment Care Compare group NPD
• Peter Buetow, MD

  • Diagnostic Radiology Physician
  • Bellingham, WA
  • NPI 1164429031

  AK

  Medicare reassignment Care Compare group NPD
• Stephen John Buetow, M.D.

  • Diagnostic Radiology Physician
  • Fort Gordon, GA
  • NPI 1386614717

  AK

  Medicare reassignment Care Compare group NPD
• Lars Crabo, MD

  • Diagnostic Radiology Physician
  • Bellingham, WA
  • NPI 1568468890

  AK

  Medicare reassignment Care Compare group NPD
• Mark Daniels, M.D.

  • Cardiovascular Disease Physician
  • Bellingham, WA
  • NPI 1831149905

  AK, Internal Medicine

  Medicare reassignment Care Compare group NPD
• Sara Jo Grethlein, MD

  • Hematology & Oncology Physician
  • Seattle, WA
  • NPI 1326083445

  AK

  Medicare reassignment Care Compare group NPD
• Robert Hughes, MD

  • Diagnostic Radiology Physician
  • Bellingham, WA
  • NPI 1679577142

  AK

  Medicare reassignment Care Compare group NPD
• Dag Jensen, MD

  • Diagnostic Radiology Physician
  • Bellingham, WA
  • NPI 1548266349

  AK

  Medicare reassignment Care Compare group NPD
• John Forbes Macgregor, M.D.

  • Clinical Cardiac Electrophysiology Physician
  • Bellingham, WA
  • NPI 1831149236

  AK

  Medicare reassignment Care Compare group NPD

The complete NPPES 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": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AK",
            "license": null,
            "primary": false
        },
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": "AK",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AK",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AK",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AK",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "AK",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "AK",
            "license": "NO NUMBERS ISSUED",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "AK",
            "license": "NO NUMBERS ISSUED",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AK",
            "license": "NO NUMBERS ISSUED",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AK",
            "license": "NO NUMBERS ISSUED",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AK",
            "license": "NO NUMBERS ISSUED",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AK",
            "license": "NO NUMBERS ISSUED",
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "AK",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HOSPITAL PRO#",
            "identifier": "6110165",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MDG235",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA CLINIC PRO#",
            "identifier": "7695464",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KETCHIKAN MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Peacehealth
• Peacehealth (PeaceHealth Hospice)
• Peacehealth (Ketchikan Medical Center)
• Peacehealth (Ketchikan Medical Center)
• Peacehealth (Ketchikan Medical Center Home Health)
• Peacehealth (Ketchikan Gen Hosp LTC)
• Jessica Peavy, CT
• Clarence Peele
• Crystal Pennino, NP-C
• Ricki Perro

• Diagnostic Radiology Physician in Ketchikan, AK
• Providers in Ketchikan, AK by specialty
• 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.