NPIMap

Organization Active NPI

Bristol Bay Area Health Corporation

  • Critical Access Hospital
  • Dillingham, AK
National Provider Identifier
1962688309
Registry record updated Apr 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
BRISTOL BAY AREA HEALTH CORPORATION
Practice address
6000 Kanakanak Rd
Dillingham, AK 99576-0130
Phone
(907) 842-5201
Fax
(907) 842-9250
NPI assigned
Jan 16, 2008
Last updated
Apr 4, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2013

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X NU Primary

Addresses

Primary practice location

6000 Kanakanak Rd
Dillingham, AK 99576-0130

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
HS26IPMedicaidAK

Other names 1

  • KANAKANAK INPATIENT HOSPITAL Other name

Medicare participation

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

Enrollment records 2

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…
O20061104000386 AK Part A Provider - Critical Access Hospital 5890699920 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dillingham, AK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962688309. Details of each certification follow.

Hospital certification: CCN 021309

Legal name
BRISTOL BAY AREA HEALTH CORPORATION
Doing business as
KANAKANAK HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Oct 1, 2004
Last certification
Sep 8, 2004
Beds
15
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jul 10, 1973 in AK
Enrollment address
6000 Kanakanak Rd
Kanakanak Hospital
Dillingham, AK 99576-0130
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 38

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

View all 38

Care Compare: Hospital

Medicare Care Compare
Listed as
Bristol Bay Dba Kanakanak HospitalCCN 021309 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Bristol Bay Area Health Corportion42 organizations share this tax ID, including this one

Other organizations with this tax ID 41

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

View all 41

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Lynn Van Vactor Individual W-2 Managing EmployeePhysician Practice Division Manager May 1, 2023 25%
Deanna Olsen Individual W-2 Managing Employee May 19, 2022
Eleanor Suesue Individual W-2 Managing EmployeeAssociate Financial Officer Jan 8, 2024 10%
Bristol Bay Area Health Corporation Organization, Dillingham, AK Corporation 5% Or Greater Direct Ownership Interest Oct 14, 2011 100%
Robert Clark Individual Corporate Director Oct 25, 2004
Jennifer Dewinne Individual Corporate DirectorChief Operations Officer/VP May 19, 2022

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 27

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 27

Affiliated clinicians 80

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

View all 80

NPI Registry JSON

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

{
    "created_epoch": "1200441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365033600000",
    "number": "1962688309",
    "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": "6000 KANAKANAK RD",
            "city": "DILLINGHAM",
            "state": "AK",
            "postal_code": "995760130",
            "telephone_number": "907-842-5201",
            "fax_number": "907-842-9250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRISTOL BAY AREA HEALTH CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-16",
        "last_updated": "2013-04-04",
        "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": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HS26IP",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KANAKANAK INPATIENT HOSPITAL",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Dillingham, AK

Sources for this page

Verify at the official NPI Registry.