NPIMap

Bristol Bay Area Health Corportion

Organization Active NPI Clinic/Center · Chignik Lake, AK

NPI 1962563676 · NPPES record last updated Oct 6, 2023

Key facts

NPI
1962563676
Entity type
Organization (NPI type 2)
Primary specialty
Clinic/Center 261Q00000X
Legal business name
BRISTOL BAY AREA HEALTH CORPORTION
Practice address
2336 Alder Lane
Chignik Lake, AK 99548
Phone
(907) 842-5201
Fax
(907) 842-9250
NPI assigned
Dec 13, 2006
Organization subpart
No

Authorized official

Name
Mr. Robert Clark
Title
Ceo
Phone
(907) 842-5201

Other NPIs on the same Medicare enrollment 38

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

View all 38

Practitioners 323

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 323

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in TX

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031120000998 TX Part B Supplier - Clinic/Group Practice 5890699920 Receives reassigned benefits from 432 practitioners
44 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lebelock, AK; Manokotak, AK; Goodnews Bay, AK; Naknek, AK; New Stuyahok, AK; Perryville, AK; Pilot Point, AK; Platinum, AK…
O20190304000785 TX Part B Supplier - Mass Immunization (Roster Biller Only) 5890699920 21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Goodnews Bay, AK; Twin Hills, AK; Togiak, AK; South Naknek, AK; Port Heiden, AK; Platinum, AK; Pilot Point, AK; Perryville, AK…

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Yes

Addresses

Primary practice location

2336 Alder Lane
Chignik Lake, AK 99548

Mailing address

PO Box 130
Dillingham, AK 99576-0130
Phone (907) 842-5201

Other names

  • CHIGNIK LAKE CLINIC Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 6, 2023.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696550400000",
    "number": "1962563676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "DILLINGHAM",
            "state": "AK",
            "postal_code": "995760130",
            "telephone_number": "907-842-5201",
            "fax_number": "907-842-9250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2336 ALDER LANE",
            "city": "CHIGNIK LAKE",
            "state": "AK",
            "postal_code": "99548",
            "telephone_number": "907-842-5201",
            "fax_number": "907-842-9250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRISTOL BAY AREA HEALTH CORPORTION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-05",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "907-842-5201",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHIGNIK LAKE CLINIC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "CHIGNIK LAKE CLINIC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chignik Lake, AK

All providers in Chignik Lake, AK · Clinic/Center in Alaska

Sources for this page

Verify at the official NPI Registry.