Maniilaq Association
Organization Active NPI Federal Public Health Clinic/Center · Selawik, AK
NPI 1821365552 · NPPES record last updated Nov 23, 2011
Key facts
- NPI
- 1821365552
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federal Public Health Clinic/Center 261QP0904X
- Legal business name
- MANIILAQ ASSOCIATION
- Practice address
- #3 Adams Landing-Old
Selawik, AK 99770 - Phone
- (907) 484-2199
- Fax
- (907) 484-2119
- NPI assigned
- Nov 23, 2011
- Organization subpart
- Yes
- Parent organization (as reported)
- MANIILAQ ASSOCIATION
Authorized official
- Name
- Mr. Paul John Hansen
- Title
- Deputy Administrator
- Phone
- (907) 445-7150
Other NPIs on the same Medicare enrollment 13
Related certifications (CCN) 1
Practitioners 14
-
James David Andrews, M.D.
-
Andrea Magyar Hiles, CNM
-
Bradley James McConnell, PSYD, ABPP
-
Julia Sicilia, M.D.
-
Morgan Bristol Whitfield, PA-C
-
Jacob Wesley Armstrong, ARNP
-
Julie H. Bryson, M.D.
-
Kyle Pohl, M.D.
-
Herbert Darren Nazuruk, CHA III
Affiliated clinicians 80
-
Jennifer R Amstadter, PA-C
-
Namory Bagayoko, MD
-
Jamie H Burford, AU.D.
-
Charles Christopher Edwards, D.P.M.
-
Robin Grant, PMHNP
-
Reinou Sybrecht Groen, M.D., M.I.H, PH.D.
-
Michelle Hinton, FNP-C
-
Linda D. Holmes, ANP
-
Keils Kitchen, PA-C
-
Meagan Lincoln, O.D.
-
Kari Marie Lundgren, PA-C
-
Angela J Manderfeld, MS, RD, CDE
-
Vivek R Mehta, M.D
-
Jolie Miller, DNP
-
Adam Nelson, PA-C
-
Ivan C Ramirez, MD
-
Winifred A Reeve, ANP
-
Andrew Garret Shacklett, M.D.
Medicare Care Compare: Hospital
- Listed as
- Maniilaq Health Center
- Type
- Critical Access Hospitals
- Ownership
- Tribal
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, AK
Hospital certification: CCN 021310
- Legal name
- MANIILAQ ASSOCIATION
- Doing business as
- MANIILAQ HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Feb 1, 2005
- Last certification
- Aug 28, 2025
- Beds
- 17
- Ownership / control type
- Tribal
- Organization structure
- Other · Non-profit
- Incorporated
- Jan 23, 1997 in AK
- Enrollment address
- 436 5TH Ave
Kotzebue, AK 99752-0043
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Johnetta Horner |
Corporate Director |
Apr 25, 2018 | 8.33% |
| Erin Jacobs |
Corporate Officer |
Jul 15, 2018 | |
| Tanya Kirk |
Corporate Director |
Apr 25, 2018 | 8.33% |
| Percy Ballot |
Corporate Director |
Oct 28, 2008 | 8.33% |
| Paul Hansen |
W-2 Managing Employee |
Oct 1, 2013 | |
| Dolly Foster |
Corporate Director |
Apr 25, 2018 | 8.33% |
| Guy L Adams |
Corporate Director |
Jan 20, 2012 | 8.33% |
| Amanda Johnson |
Corporate Director |
Apr 25, 2018 | 8.33% |
| Eva Kinneeveauk |
Corporate Director |
May 29, 2012 | 8.33% |
| Emerson Moto |
Corporate Director |
Feb 19, 2005 | 8.33% |
| Tim Gilbert |
Corporate Officer |
Jun 12, 2017 | 100% |
| Lorena Walker |
Corporate Director |
Apr 25, 2018 | 8.33% |
| Diana Ramoth |
Corporate Director |
Apr 25, 2018 | 8.33% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041123000372 | TX | Part B Supplier - Clinic/Group Practice | 6103881792 |
Receives reassigned benefits from 218 practitioners 12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Shungnak, AK; Selawik, AK; PT Hope, AK; Noorvik, AK; Noatak, AK; Kotzebue, AK; Kobuk, AK; Ambler, AK… |
| O20120119000556 | AK | Part a Provider - Critical Access Hospital | 6103881792 |
Receives reassigned benefits from 73 practitioners 11 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Kotzebue, AK |
National Provider Directory
- Part of
- Buckland Clinic
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federal Public Health Clinic/Center | 261QP0904X | Yes |
Addresses
Primary practice location
#3 Adams Landing-Old
Selawik, AK 99770
Mailing address
P.O. Box 43
Kotzebue, AK 99752-0043
Phone (907) 442-7150
Other names
- Selawik Clinic
Other providers in Selawik, AK
- Marlene A Gray
- Bertha Greist
- Mildred Sarah Greist
- Mary Lorraine Hingsbergen
- Maniilaq Association
- Herbert Darren Nazuruk
- Nora Ramoth
- Lester Sampson
- Elizabeth Sours
- Maureen Colleen Ticket
All providers in Selawik, AK · Federal Public Health Clinic/Center in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 23, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.