NPIMap

Organization Active NPI

Fairbanks Memorial Hospital, LLC

  • Community Based Hospice Care Agency
  • Fairbanks, AK
National Provider Identifier
1881145571
Registry record updated Oct 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
FAIRBANKS MEMORIAL HOSPITAL, LLC
Practice address
2001 Gillam Way
Fairbanks, AK 99701-6026
Phone
(907) 458-3090
NPI assigned
Oct 18, 2016
Last updated
Oct 2, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
FOUNDATION HEALTH, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 2, 2023

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

Authorized official

Name
Anthony G Sudduth
Title
Cfo
Phone
(907) 458-5300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X NU Primary

Addresses

Primary practice location

2001 Gillam Way
Fairbanks, AK 99701-6026

Mailing address

2001 Gillam Way
Fairbanks, AK 99701-6026
Phone (907) 458-3090

Other names 1

  • Fairbanks Memorial Hospice Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170104000967 AK Part A Provider - Hospice 2961783048 Practice locations: Fairbanks, AK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881145571. Details of each certification follow.

Hospice certification: CCN 021507

Legal name
FAIRBANKS MEMORIAL HOSPITAL LLC
Doing business as
FAIRBANKS MEMORIAL HOSPITAL HOSPICE SERVICES
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jan 14, 2013
Last certification
Jan 14, 2013
Ownership / control type
Non-Profit - Other
Organization structure
LLCNon-profit
Incorporated
May 6, 2016 in AK
Enrollment address
2001 Gillam Way
Fairbanks, AK 99701-6026

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Fairbanks Memorial Hospital Hospice ServicesCCN 021507 · All quality measures
Ownership
Non-Profit
Certified
Jan 14, 2013
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Fairbanks Memorial Hospital LLC7 organizations share this tax ID, including this one
Part of
Foundation Health LLC

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2001 Gillam Way
Fairbanks, AK 99701
Phone (907) 458-3090

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Greater Fairbanks Community Hospital Foundation Inc Organization, Fairbanks, AK Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jan 2, 2017 100%
Shelley D Ebenal Individual Corporate OfficerChief Executive Officer Feb 24, 2019 100%
W-2 Managing EmployeeChief Executive Officer Feb 24, 2019 100%
Operational/Managerial ControlChief Executive Officer Feb 24, 2019 100%
Sarah Martin Individual W-2 Managing EmployeeCno Jan 1, 2017 100%
Operational/Managerial ControlCno Jan 1, 2017 100%
Anthony G Sudduth Individual Corporate OfficerChief Financial Officer Jul 24, 2023 100%
W-2 Managing EmployeeChief Financial Officer Jul 24, 2023 100%
Operational/Managerial ControlChief Financial Officer Jul 24, 2023 100%
Karen Ruth Perdue Individual Corporate OfficerBoard Secretary Nov 1, 2022 100%
Corporate DirectorBoard Secretary Nov 1, 2022 100%
Scott Bell Individual Corporate OfficerPresident Nov 1, 2022 100%
Corporate DirectorBoard of Directors Jan 1, 2013 100%
Steve Frank Individual Corporate OfficerSecretary Nov 1, 2022 100%
Corporate DirectorBoard of Directors Jan 1, 2019 100%
Joseph Faulhaber Individual Corporate OfficerVice President Nov 1, 2022 100%
Corporate DirectorMember Board of Directors Jan 1, 2017 100%
Foundation Health LLC Organization, Fairbanks, AK LLC, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2017 100%

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1476748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696204800000",
    "number": "1881145571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 GILLAM WAY",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997016026",
            "telephone_number": "907-458-3090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 GILLAM WAY",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997016026",
            "telephone_number": "907-458-3090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRBANKS MEMORIAL HOSPITAL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FOUNDATION HEALTH, LLC",
        "enumeration_date": "2016-10-18",
        "last_updated": "2023-10-02",
        "certification_date": "2023-10-02",
        "status": "A",
        "authorized_official_last_name": "SUDDUTH",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "907-458-5300"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairbanks Memorial Hospice",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Fairbanks Memorial Hospice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fairbanks, AK

Sources for this page

Verify at the official NPI Registry.