NPIMap

Organization Active NPI

Bethel Family Clinic

  • Federally Qualified Health Center (FQHC)
  • Bethel, AK
National Provider Identifier
1891279097
Registry record updated Nov 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BETHEL FAMILY CLINIC
Practice address
430 Main Street
Bethel, AK 99559-1908
Phone
(907) 543-3773
NPI assigned
Sep 24, 2018
Last updated
Nov 28, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
BETHEL FAMILY CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 28, 2018

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

Authorized official

Name
Suzanne Niemi
Title
Finance
Phone
(907) 543-9852

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

430 Main Street
Bethel, AK 99559-1908

Mailing address

PO Box 1908
Bethel, AK 99559-1908
Phone (907) 543-3773

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040311000904 AK Part B Supplier - Clinic/Group Practice 7719876416 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bethel, AK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891279097. Details of each certification follow.

  • CCN 021854 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 021854

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
BETHEL FAMILY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 24, 2019
Last certification
Apr 24, 2019
Ownership / control type
For profit – corporation
Facility address
430 Main Street
Bethel, AK 99559

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
02D0705422Bethel Family Clinic430 Main Street, Bethel, AK 99559Certificate of waiverJun 28, 2028

National Provider Directory

National Provider Directory
Part of
Bethel Family Clinic Inc

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1537747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543363200000",
    "number": "1891279097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1908",
            "city": "BETHEL",
            "state": "AK",
            "postal_code": "995591908",
            "telephone_number": "907-543-3773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 MAIN STREET",
            "city": "BETHEL",
            "state": "AK",
            "postal_code": "995591908",
            "telephone_number": "907-543-3773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHEL FAMILY CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BETHEL FAMILY CLINIC",
        "enumeration_date": "2018-09-24",
        "last_updated": "2018-11-28",
        "status": "A",
        "authorized_official_last_name": "NIEMI",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_title_or_position": "FINANCE",
        "authorized_official_telephone_number": "907-543-9852"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethel, AK

Sources for this page

Verify at the official NPI Registry.