BETHEL FAMILY CLINIC
NPI 1124078019
Clinic/Center - Federally Qualified Health Center (FQHC) in Bethel, AK

Active since May 11, 2006CLIA 02D0705422 · Waiver
631 MAIN STREET, BETHEL, AK 99559(907) 543-3773(907) 543-3545 Get Directions Write a Review

NPPES record last updated: November 27, 2018. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Nov 27, 2018, Sep 6, 2018 (2 updates tracked since 2018).

About Bethel Family Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BETHEL FAMILY CLINIC (NPI 1124078019) is a healthcare organization registered as a federally qualified health center (fqhc) in Bethel, Alaska and active in the NPI registry since May 2006. The organization holds a CLIA Waiver certificate valid through June 28, 2028 and lists Suzanne Niemi, Finance, as its authorized official.

NPPES Registry Identity

NPI1124078019
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NameBETHEL FAMILY CLINIC
Location Address631 MAIN STREETBethel, AK 99559-1908
Mailing AddressPo Box 1908, 631 Main StreetBethel, AK 99559-1908 · (907) 543-3773 · Fax (907) 543-3545
Fax(907) 543-3545
Organization SubpartNo
Authorized OfficialSuzanne NiemiFinance · (907) 543-9852
Enumeration DateMay 11, 2006
Last NPPES UpdateNovember 27, 20182 updates tracked since enumeration
NPI 1124078019 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
Taxonomy Code261QF0400X
631 MAIN STREET, Bethel, AK 99559

Other Identifiers 2

Medicaid1029936AK
Other02-1835AK · Medicare Part A Ptan

Accepted Insurance

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 02D0705422

Bethel Family Clinic · Bethel, AK
Active · expires Jun 28, 2028
CLIA Number02D0705422
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateJune 29, 2026
Certificate Expiration DateJune 28, 2028
Laboratory DirectorDr. Cormac A. Sookram
Laboratory Phone(907) 543-3773
Laboratory LocationBethel Family Clinic430 Main Street, Bethel, AK 99559
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Practitioner
631 MAIN STREET
BETHEL, AK 99559
Nurse Practitioner (Family)
631 MAIN STREET
BETHEL, AK 99559
Nurse Practitioner (Family)
631 MAIN STREET
BETHEL, AK 99559

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bethel Family Clinic's NPI number?

The NPI number for Bethel Family Clinic is 1124078019. It was assigned to this organization in the NPPES registry on May 11, 2006.

Where is Bethel Family Clinic located?

Bethel Family Clinic is located at 631 Main Street, Bethel, AK 99559. The listed phone number is (907) 543-3773.

What is Bethel Family Clinic's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Does Bethel Family Clinic hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 02D0705422) is associated with this NPI, valid through June 28, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Bethel Family Clinic accept?

Health plans from Premera Blue Cross Blue Shield of Alaska list Bethel Family Clinic as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Bethel Family Clinic was last updated on November 27, 2018. NPI Profile syncs with the weekly NPPES data releases published by CMS.