KODIAK AREA NATIVE ASSOCIATION NPI 1205883907

Clinic/Center (Dental) in Kodiak, AK

NPI 1205883907 Organization Clinic/Center Dental CLIA Number 02D2136079 CLIA Certificate for Provider-Performed Microscopy Procedures (PPMP)

NPI Profile for KODIAK AREA NATIVE ASSOCIATION

Kodiak Area Native Association is a provider established in Kodiak, Alaska specializing in clinic/center (dental) . The NPI number of Kodiak Area Native Association is 1205883907 and was assigned on May 2006. The practitioner's primary taxonomy code is 261QD0000X with license number 233103 (AK). The provider is registered as an organization and their NPI record was last updated 12 years ago. The authorized official of this NPI record is Mr. Andrew Teuber (President/ceo)

The CLIA number of Kodiak Area Native Association is 02D2136079 registered as a "federally qualified health center" facility with a CLIA Certificate for Provider-Performed Microscopy Procedures (PPMP). This CLIA certificate is issued to Kodiak Area Native Association in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.

NPI

1205883907

Provider NameKODIAK AREA NATIVE ASSOCIATION
Provider Location Address3449 E REZANOF DR KODIAK, AK 99615
Provider Mailing Address3449 E REZANOF DR KODIAK, AK 99615
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date05-28-2006
Last Update Date03-25-2010


Primary Taxonomy

Taxonomy Code261QD0000X
ClassificationClinic/Center
TypeAmbulatory Health Care Facilities
SpecializationDental
License No.233103
License StateAK

Business Address

KODIAK AREA NATIVE ASSOCIATION
3449 E REZANOF DR
KODIAK, AK
ZIP 99615
Phone: (907) 486-9800
Fax: (907) 486-9897

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Mailing Address

KODIAK AREA NATIVE ASSOCIATION
3449 E REZANOF DR
KODIAK, AK
ZIP 99615
Phone: (907) 486-9800
Fax: (907) 486-9897



Authorized Official

Authorized Official NameMR. ANDREW TEUBER
Authorized Official TitlePRESIDENT/CEO
Authorized Official Phone(907) 486-9800

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1205883907 is:

CLIA Number02D2136079
Facility TypeFEDERALLY QUALIFIED HEALTH CENTER
Certificate TypeCertificate for Provider-Performed Microscopy Procedures (PPMP)

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
DDG978MEDICAID (05)AK

NPI Validation Check Digit Calculation


The following table explains step by step the NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1205883907
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2205168690
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 2 + 0 + 5 + 1 + 6 + 8 + 6 + 9 + 0 + 24 = 63
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 63 = 77

The NPI number 1205883907 is valid because the calculated check digit 7 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the same location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1679514236KODIAK AREA NATIVE ASSOCIATION
Organization
Clinic/Center (Multi-Specialty)3449 E REZANOF DR
KODIAK, AK 99615
(907) 486-9800
1912091935 CHARLES W PHILLIPS DD
Individual
Dentist (General Practice)3449 E REZANOF DR
KODIAK, AK 99615
(907) 486-9800
1003973041KODIAK AREA NATIVE ASSOCIATION PHARMACY
Organization
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy3449 E REZANOF DR
KODIAK, AK 99615
(907) 486-9860
1639220288 AMELIA LOPEZ
Individual
Preventive Medicine (Public Health & General Preventive Medicine)3449 E REZANOF DR
KODIAK, AK 99615
(907) 486-3479
1518094481 AMANDA VIVIAN SANFORD
Individual
Case Manager/Care Coordinator3449 E REZANOF DR
KODIAK, AK 99615
(907) 486-1367
1518094416 NANCY JEAN WELLS
Individual
Case Manager/Care Coordinator3449 E REZANOF DR
KODIAK, AK 99615
(907) 486-1366
1770617466DR. BRIAN M NAROG PHARM.D.
Individual
Pharmacist3449 E REZANOF DR
KODIAK, AK 99615
(907) 486-9860
1669695466 STEVE SMITH HYGIENIST
Individual
Dental Hygienist3449 E REZANOF DR
KODIAK, AK 99615
(907) 486-9820
1063634491 MICHAEL HANDRICKS
Individual
Counselor3449 E REZANOF DR
KODIAK, AK 99615
(907) 486-9824
1801091749MRS. LAURA JANELLE MCDERMOTT LMFT
Individual
Marriage & Family Therapist3449 E REZANOF DR BEHAVIORAL HEALTH
KODIAK, AK 99615
(860) 550-1713
1295914877MRS. SHANA J JONES RN
Individual
General Practice3449 E REZANOF DR
KODIAK, AK 99615
(907) 486-9800
1477732980 NADIYA JAMES RN
Individual
General Practice3449 E REZANOF DR
KODIAK, AK 99615
(907) 486-9800
1598946923 CHERIE COWAN DO
Individual
Dental Hygienist3449 E REZANOF DR
KODIAK, AK 99615
(907) 486-9850
1740464437 HEATHER PARKER DO
Individual
Dental Hygienist3449 E REZANOF DR
KODIAK, AK 99615
(907) 486-9850
1508034075 AMIE K ARNOLD CDC I, BHA
Individual
Counselor (Addiction (Substance Use Disorder))3449 E REZANOF DR
KODIAK, AK 99615
(907) 486-9800
1467611699 GEORGIA J BLAIN
Individual
General Practice3449 E REZANOF DR
KODIAK, AK 99615
(907) 486-9870
1215196423 DIANE C WOLKOFF
Individual
General Practice3449 E REZANOF DR
KODIAK, AK 99615
(907) 486-9870
1669631891 JUDITH K SPOERER
Individual
General Practice3449 E REZANOF DR
KODIAK, AK 99615
(907) 486-9870
1275792913 MARSHA R MADRIAGA
Individual
Phlebology3449 E REZANOF DR
KODIAK, AK 99615
(907) 486-9870
1760643621 JENNIFER R MOE
Individual
General Practice3449 E REZANOF DR
KODIAK, AK 99615
(907) 486-9870

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
Kodiak Area Native Association is registered as an entity type code: 2. The entity type code describes the type of health care provider that is being assigned an NPI. The entity type codes are:

  • 1 = Person: individual human being who furnishes health care.
  • 2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.