Active NPI
Thomas Mitchell Gibson, HEALTH AID
- Community Health Worker
- Nelson Lagoon, AK
National Provider Identifier
1881074789
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 06-891-IV
- Practice address
- 40 Mainstreet
Paul Martin Gundersen Memorial Clinic
Nelson Lagoon, AK 99751 - Phone
- (907) 989-2202
- Fax
- (907) 989-2245
- NPI assigned
- Jun 5, 2015
- Last updated
- Jun 5, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 06-891-IV | AK | Primary |
Addresses
Primary practice location
40 Mainstreet
Paul Martin Gundersen Memorial Clinic
Nelson Lagoon, AK 99751
Mailing address
3380 C Street, Eastern Aleutian Tribes
Suite 100
Anchorage, AK 99503
Phone (907) 277-1440
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 06-891-IV | Other | AK | ALASKA COMMUNITY HEALTH AID CERTIFICATION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06-891-IV | AK | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433462400000",
"number": "1881074789",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3380 C STREET, EASTERN ALEUTIAN TRIBES",
"address_2": "SUITE 100",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "99503",
"telephone_number": "907-277-1440",
"fax_number": "907-277-1446"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 MAINSTREET",
"address_2": "PAUL MARTIN GUNDERSEN MEMORIAL CLINIC",
"city": "NELSON LAGOON",
"state": "AK",
"postal_code": "99751",
"telephone_number": "907-989-2202",
"fax_number": "907-989-2245"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "THOMAS",
"middle_name": "MITCHELL",
"name_prefix": "Mr.",
"credential": "HEALTH AID",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-06-05",
"last_updated": "2015-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "AK",
"license": "06-891-IV",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALASKA COMMUNITY HEALTH AID CERTIFICATION",
"identifier": "06-891-IV",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Nelson Lagoon, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.