SOUTH PENINSULA HOSPITAL, INC (NPI# 1093968372) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093968372 |
| Entity Type | Organization |
| Organization Name | SOUTH PENINSULA HOSPITAL, INC |
| Practice Address |
4300 Bartlett St Homer AK 99603-7005 |
| Practice Telephone | 9072358101 |
| Practice Fax Number | 9072350253 |
| Mailing Telephone | 9072358101 |
| Mailing Fax Number | 9072350253 |
| Enumeration Date | 2008-10-30 |
| Last Update Date | 2020-02-07 |
| Authorized Official Name | MR. RYAN SMITH (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 9072350241 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 275N00000X | Medicare Defined Swing Bed Unit | 192072 | AK | Hospital Units |
| N | 282N00000X | General Acute Care Hospital | Hospitals | ||
| N | 313M00000X | Nursing Facility/Intermediate Care Facility | Nursing & Custodial Care Facilities | ||
| N | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities | ||
| Y | 282NC0060X |
General Acute Care Hospital Specialization: Critical Access |
192072 | AK | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | 1582637 | 05 | |
| AK | 1582664 | 05 | |
| AK | 1687514 | 05 | |
| AK | 1005653 | 05 | |
| AK | 1005654 | 05 | |
| AK | 1020634 | 05 | |
| AK | 1687518 | 05 | |
| AK | 1701931 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164400750 | South Peninsula Hospital, Inc | Home Health | 203 W Pioneer Ave, Homer, AK 99603-7527 | 2006-01-04 |
| Street Address |
4300 BARTLETT ST |
| City | HOMER |
| State | AK |
| Zip Code | 99603-7005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104808070 | Raymond D. Fowler | Anesthesiology | 4300 Bartlett St, South Penisula Hospital, Homer, AK 99603-7005 | 2005-11-16 |
| 1982229290 | Rachael Brown Kincaid | Nurse Practitioner | 4300 Bartlett St, Homer, AK 99603-7000 | 2020-06-11 |
| 1619521812 | Richard John Kleinleder | Physical Therapy Assistant | 4300 Bartlett St, Homer, AK 99603-7005 | 2019-07-26 |
| 1073167284 | Neil Schott | Physical Therapist | 4300 Bartlett St, Homer, AK 99603 | 2019-07-25 |
| 1366843187 | Valaree Carney | Registered Nurse | 4300 Bartlett St, Homer, AK 99603-7005 | 2014-09-11 |
| 1457751562 | Sandy Kaye Miller | Case Manager/Care Coordinator | 4300 Bartlett St, Homer, AK 99603 | 2014-08-26 |
| 1003248162 | Michelle Hosford | Case Manager/Care Coordinator | 4300 Bartlett St, Homer, AK 99603-7005 | 2013-07-31 |
| 1437433620 | Amy Louise Christiansen | Registered Nurse | 4300 Bartlett St, Attn:a. Christiansen Rn @community Health Services, Homer, AK 99603-7005 | 2011-10-05 |
| 1417117086 | Sarah L Roberts | Family Medicine | 4300 Bartlett St, Homer, AK 99603-7005 | 2008-06-16 |
| 1588874382 | Karen Anne Northrop | Physical Therapist | 4300 Bartlett St, Homer, AK 99603 | 2007-05-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518572387 | Morgan Dwyer | Counselor | 51310 Timber Bay Ct, Homer, AK 99603 | 2020-09-09 |
| 1346859824 | John George Hetrick | Counselor | 51310 Timber Bay Ct., Homer, AK 99603 | 2020-07-30 |
| 1093352502 | Katieostrommd | Obstetrics & Gynecology | 205 W Fairview, Homer, AK 99603 | 2019-12-03 |
| 1023651965 | Melissa Elizabeth Malcolm | Physical Therapy Assistant | 4107 Hohe Ave, Homer, AK 99603 | 2019-10-23 |
| 1184143620 | Homer Birth and Wellness Center | Clinic/Center | 3902 Shelford Street, Homer, AK 99603 | 2017-09-15 |
| 1588913271 | Sharon Marie Gorman | Registered Nurse | 3959 Ben Walters, Homer, AK 99603 | 2012-09-10 |
| 1477802197 | Aldergrove Assisted Living | Community Based Residential Treatment Facility, Mental Illness | 41045 Denny Lane, Homer, AK 99603 | 2012-09-10 |
| 1194087551 | Stephen Michael Mueller | Pharmacist | 3858 Lake Street, Suite #5, Lakeside Mall, Homer, AK 99603 | 2012-06-12 |
| 1962778001 | Homer Dental Center Inc | Dentist | 4014 Lake St., Ste 210, Homer, AK 99603 | 2012-03-22 |
| 1346544368 | William R Easton | General Practice | 2495 Bayridge Rd, Homer, AK 99603 | 2011-01-05 |
| Find all providers in zip 99603 | ||||
| Taxonomy Code | 282NC0060X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| Specialization | Critical Access |
| Definition to come. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295855666 | Norton Sound Health Corp | General Acute Care Hospital | Nshc, 306 W 5th, Nome, AK 99762 | 2007-03-30 |
| 1306933643 | Arctic Slope Native Association Ltd | General Acute Care Hospital | 7000 Uula Street, Barrow, AK 99723 | 2006-10-06 |
| 1518955731 | Wrangell Medical Center | General Acute Care Hospital | 310 Bennett Street, Wrangell, AK 99929-1081 | 2005-10-11 |
| 1013905660 | Providence Health & Services Washington | General Acute Care Hospital | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | 2005-10-07 |
| 1871996975 | Norton Sound Health Corp Physical Teraphy | General Acute Care Hospital | 1000 Greg Kruschek Ave, Nome, AK 99762 | 2014-10-02 |
| 1780085381 | Sitka Community Hospital | General Acute Care Hospital | 209 Moller Ave, Sitka, AK 99835-7142 | 2014-09-15 |
| 1588902027 | Norton Sound Health Corp | General Acute Care Hospital | 1000 Greg Kruschek Ave, Nome, AK 99762 | 2013-01-17 |
| 1487898110 | Searhc Mt Edcumbe Hospital | General Acute Care Hospital | 222 Tongass Dr, Sitka, AK 99835-9416 | 2009-04-24 |
| 1962688309 | Bristol Bay Area Health Corporation | General Acute Care Hospital | 6000 Kanakanak Rd, Dillingham, AK 99576-0130 | 2008-01-16 |
| 1578758744 | Samuel Simmonds Memorial Hospital | General Acute Care Hospital | 1296 Agvik Street, Barrow, AK 99723-0029 | 2007-09-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.