NPIMap

Organization Active NPI

Girdwood Health Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Girdwood, AK
National Provider Identifier
1851662233
Registry record updated Dec 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GIRDWOOD HEALTH CLINIC, INC.
Practice address
131 Lindblad Avenue
Girdwood, AK 99587
Phone
(907) 783-1355
Fax
(907) 783-1357
NPI assigned
Jan 18, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2022

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

Authorized official

Name
Suzanne Niemi
Title
Cfo
Phone
(907) 783-1355

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X AK
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

131 Lindblad Avenue
Girdwood, AK 99587

Mailing address

PO Box 1130
Girdwood, AK 99587-1130
Phone (907) 783-1355

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120427000146 AK Part B Supplier - Clinic/Group Practice 4688836216 Receives reassigned benefits from 8 practitioners
Practice locations: Girdwood, AK
O20151214001776 AK Part A Provider - Federally Qualified Health Center (FQHC) 4688836216 Practice locations: Girdwood, AK

Federally qualified health center certification: CCN 021848

Legal name
GIRDWOOD HEALTH CLINIC, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 14, 2015
Last certification
Dec 14, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 28, 2011 in AK
Enrollment address
131 Lindblad Avenue
Girdwood, AK 99587

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
02D0884007Girdwood Health Clinic, Inc131 Lindblad Avenue, Girdwood, AK 99587Certificate of waiverNov 9, 2026

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8748/brand/1/csg/1/fhir/r4

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Rebecca Marinelli Individual W-2 Managing EmployeeDirector of Risk and Admin Complian Apr 6, 2020
Stacy Kelley Individual Corporate DirectorBoard Member Nov 1, 2022
Marcia Seifert Individual Corporate DirectorBoard Member Feb 18, 2016
Kaleen Haines Individual Corporate DirectorBoard Member Nov 1, 2021
Shari Harrison Individual Corporate DirectorBoard Member Jul 20, 2016
Deborah L Erickson Individual Corporate OfficerChief Executive Officer Jul 29, 2024
W-2 Managing EmployeeChief Executive Officer Jul 29, 2024
Anna Moran Individual Corporate OfficerBoard Treasurer Sep 12, 2018
Alice Simmons Individual Corporate DirectorBoard Vice Chair Oct 20, 2022
Christine Johnson Individual Corporate OfficerBoard Secretary Sep 17, 2020
Charla Hughes Individual Corporate OfficerBoard Chair Aug 18, 2022
Deanna Swatek Nafzger Individual Corporate DirectorBoard Member Mar 18, 2024
Suzanne Niemi Individual Corporate Officer May 30, 2022
W-2 Managing EmployeeChief Financial Officer May 30, 2022

Practitioners & affiliated clinicians

Practitioners 9

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": "1326844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671494400000",
    "number": "1851662233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1130",
            "city": "GIRDWOOD",
            "state": "AK",
            "postal_code": "995871130",
            "telephone_number": "907-783-1355",
            "fax_number": "907-783-1357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 LINDBLAD AVENUE",
            "city": "GIRDWOOD",
            "state": "AK",
            "postal_code": "99587",
            "telephone_number": "907-783-1355",
            "fax_number": "907-783-1357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIRDWOOD HEALTH CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-18",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A",
        "authorized_official_last_name": "NIEMI",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "907-783-1355"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "AK",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Girdwood, AK

Sources for this page

Verify at the official NPI Registry.