NPIMap

Organization Active NPI

Independence Healthcare PC

  • Medical Specialty Clinic/Center
  • Soldotna, AK
National Provider Identifier
1891790184
Registry record updated Mar 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
264120 Issued in AK
Legal business name
INDEPENDENCE HEALTHCARE PC
Practice address
289 N Fireweed St Ste D
Soldotna, AK 99669-7570
Phone
(907) 262-6454
Fax
(907) 262-0832
NPI assigned
Jun 14, 2005
Last updated
Mar 14, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2024

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

Authorized official

Name
Dr. Henry G Krull, MDNPI 1669477790
Title
President
Phone
(907) 262-6454

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X 264120 AK Primary

Addresses

Primary practice location

289 N Fireweed St Ste D
Soldotna, AK 99669-7570

Mailing address

291 N Fireweed St
Soldotna, AK 99669-7540
Phone (907) 262-6454

Other identifiers 3

IdentifierTypeStateIssuer
264120OtherAKAK. BUSINESS LICENSE
4127920001OtherAKDMERC SUPPLIER NO.
MDG 575MedicaidAK

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040413001235 AK Part B Supplier - Clinic/Group Practice 0648264549 Receives reassigned benefits from 21 practitioners
Practice locations: Kenai, AK; Soldotna, AK
O20150811005778 AK DME Supplier - Physician - Orthopedic/Orthopedic Surgery 0648264549 Practice locations: Soldotna, AK

National Provider Directory

National Provider Directory

Locations

130 S Willow St
Ste 1
Kenai, AK 99611
Phone (907) 262-2596

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710374400000",
    "number": "1891790184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "291 N FIREWEED ST",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996697540",
            "telephone_number": "907-262-6454",
            "fax_number": "907-262-0832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "289 N FIREWEED ST STE D",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996697570",
            "telephone_number": "907-262-6454",
            "fax_number": "907-262-0832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE HEALTHCARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-14",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A",
        "authorized_official_last_name": "KRULL",
        "authorized_official_first_name": "HENRY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "907-262-6454",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "AK",
            "license": "264120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AK. BUSINESS LICENSE",
            "identifier": "264120",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC SUPPLIER NO.",
            "identifier": "4127920001",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MDG 575",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Soldotna, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.