PEACEHEALTH
NPI 1235556846
Surgery in Ketchikan, AK

NPI Status: Active since March 20, 2014

Contact Information

212 CARLANNA LAKE RD
#204
KETCHIKAN, AK
ZIP 99901
Phone: (907) 225-7346

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  • Organization
  • Surgery
  • CLIA Number: 02D2026103
  • CLIA Cert. Type: Rural Health Clinic
  • CLIA Exp. Date: 06-22-2027

About PEACEHEALTH

This page provides the complete NPI Profile along with additional information for Peacehealth, a provider established in Ketchikan, Alaska operating as a Surgery. The healthcare provider is registered in the NPI registry with number 1235556846 assigned on March 2014. The practitioner's primary taxonomy code is 208600000X with license number 5790 (AK). The provider is registered as an organization and their NPI record was last updated 12 years ago. Peacehealth operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Lori Mccoy (Provider Enrollment Specialist)

NPI
1235556846
Provider Name
PEACEHEALTH
Entity Type
Organization
Location Address
212 CARLANNA LAKE RD #204 KETCHIKAN, AK 99901
Location Phone
(907) 225-7346
Mailing Address
1115 SE 164TH AVE DEPT 358 VANCOUVER, WA 98683
Mailing Phone
(360) 729-1411
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
03-20-2014
Last Update Date
03-20-2014
Code Navigator

A surgeon like Peacehealth treats injuries, diseases, and deformities through surgical operations. A surgeon could correct physical deformities, repair bone and tissue, or perform preventive or elective surgeries. Surgeons also examine patients, perform and interpret diagnostic tests, and provide counsel on preventive healthcare.

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Surgery

Taxonomy Code
208600000X
Type
Allopathic & Osteopathic Physicians
License No.
5790
License State
AK
Taxonomy Description
A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

Group Taxonomy 193200000X MULTI-SPECIALTY GROUP

This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

LORI MCCOY

Authorized Official Title
PROVIDER ENROLLMENT SPECIALIST
Authorized Official Phone
(360) 729-1411

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
K163430MEDICARE PIN (08)AK 

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 this NPI number is:

CLIA Number
02D2026103
Facility Type
Rural Health Clinic
Certificate Effective Date
June 23, 2025
Certificate Expiration Date
June 22, 2027
Laboratory Director
DR. NICOLE A. MORIN
Certificate Type
Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description
This CLIA certificate is issued to Peacehealth 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.

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NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1235556846, we treat the final digit (6) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 64. The final step is to find the difference between that total and the next multiple of ten (70 - 64 = 6).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1
1
Doubled → 2
Pos 2
2
Unchanged
Pos 3
3
Doubled → 6
Pos 4
5
Unchanged
Pos 5
5
Doubled → 10 → 1 + 0
Pos 6
5
Unchanged
Pos 7
6
Doubled → 12 → 1 + 2
Pos 8
8
Unchanged
Pos 9
4
Doubled → 8
Check
6
Target digit
Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 3 → 6 5 → 10 → 1 6 → 12 → 3 4 → 8

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 2 + 6 + 5 + 1 + 0 + 5 + 1 + 2 + 8 + 8 + 24 = 64

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 64 is 70. The difference is the calculated check digit.

70 - 64 = 6
This NPI is valid
The calculated check digit is 6, which matches the last digit of 1235556846.

Other Providers at the Same Location


The following 3 providers are registered at the same or a nearby location.

Otolaryngology
212 CARLANNA LAKE RD
KETCHIKAN, AK 99901
Nurse Practitioner (Adult Health)
212 CARLANNA LAKE RD, 100
KETCHIKAN, AK 99901
Otolaryngology
212 CARLANNA LAKE RD, SUITE 201
KETCHIKAN, AK 99901

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1235556846, enumerated as an "organization" on March 20, 2014.

The provider is located at 212 CARLANNA LAKE RD #204 KETCHIKAN, AK 99901 and the phone number is (907) 225-7346.

Surgery with taxonomy code 208600000X.

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.