NPIMap

Organization Active NPI

Jefferson County Public Hospital District No 2

Doing business as Jefferson Healthcare Express Clinic

  • Rural Health Clinic/Center
  • Port Townsend, WA
National Provider Identifier
1013421114
Registry record updated Dec 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Doing business as
Jefferson Healthcare Express Clinic
Practice address
1274 7TH St Ste a
Port Townsend, WA 98368-2404
Phone
(360) 385-2204
Fax
(360) 385-3095
NPI assigned
Nov 28, 2017
Last updated
Dec 31, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2025

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

Authorized official

Name
Mike Glenn
Title
Ceo
Phone
(360) 385-2200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1274 7TH St Ste a
Port Townsend, WA 98368-2404

Mailing address

PO Box 104546
Pasadena, CA 91189-4546
Phone (360) 385-2200

Other names 1

  • Jefferson Healthcare Express Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031111000542 WA Part B Supplier - Clinic/Group Practice 4789593708 Receives reassigned benefits from 231 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Quilcene, WA; Port Townsend, WA; Port Ludlow, WA; Bellingham, WA
O20180119000676 WA Part A Provider - Rural Health Clinic 4789593708 Practice locations: Port Townsend, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013421114. Details of each certification follow.

Rural health clinic certification: CCN 508574

Legal name
JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Doing business as
JEFFERSON HEALTHCARE EXPRESS CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 20, 2018
Last certification
Apr 20, 2018
Ownership / control type
1B
Organization structure
CorporationNon-profit
Enrollment address
1274 7TH St
Ste a
Port Townsend, WA 98368-2404
Related CCNs
501323

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

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 9

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2143971Jefferson Healthcare Express Clinic1274 7TH St Ste a, Port Townsend, WA 98368Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Locations

834 Sheridan St
#B
Port Townsend, WA 98368
Phone (360) 385-2204

Networks

  • devoted network organization-83621310-88c0-4660-8f8d-b8ea8f4dc04e

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Bruce McComas Individual Corporate DirectorBoard Member Jan 1, 2018
Operational/Managerial ControlBoard Member Jan 1, 2018
Cornelis Kolff Individual Corporate DirectorBoard Member Jan 1, 2016
Operational/Managerial ControlBoard Member Jan 1, 2016
Tyler Freeman Individual Corporate OfficerCfo Apr 19, 2021
Brandie Manuel Individual Corporate OfficerChief Patient Care Officer Nov 12, 2020
Corporate DirectorChief Patient Care Officer Nov 12, 2020
Matthew W Ready Individual Corporate DirectorBoard Member Jan 1, 2014 100%
Operational/Managerial ControlBoard Member Jan 1, 2014 100%
Lawrence M Glenn Individual Corporate DirectorBoard Member Oct 4, 2010 100%
Operational/Managerial ControlBoard Member Oct 4, 2010 100%
Jill E Buhler Individual Corporate DirectorBoard Member Mar 2, 1995 100%
Operational/Managerial ControlBoard Member Mar 2, 1995 100%
Marie L Dressler Individual Corporate DirectorBoard Member Jan 1, 2010 100%
Operational/Managerial ControlBoard Member Jan 1, 2010 100%

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Jefferson Healthcare Home HealthPort Townsend, WA, CCN 507050 Home health agency Operational/Managerial Control Jan 1, 2003
Jefferson Healthcare Home Health and HospicePort Townsend, WA, CCN 501538 Hospice Operational/Managerial Control Aug 5, 2010

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1511827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767139200000",
    "number": "1013421114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 104546",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911894546",
            "telephone_number": "360-385-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1274 7TH ST STE A",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983682404",
            "telephone_number": "360-385-2204",
            "fax_number": "360-385-3095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-28",
        "last_updated": "2025-12-31",
        "certification_date": "2025-12-31",
        "status": "A",
        "authorized_official_last_name": "GLENN",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "360-385-2200"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Healthcare Express Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Townsend, WA

Sources for this page

Verify at the official NPI Registry.