NPIMap

Organization Active NPI

Grant County Public Hospital District No 5

Doing business as Mattawa Community Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Mattawa, WA
National Provider Identifier
1013743210
Registry record updated Dec 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GRANT COUNTY PUBLIC HOSPITAL DISTRICT NO 5
Doing business as
Mattawa Community Medical Clinic
Practice address
206 Government Rd
Mattawa, WA 99349-5116
Phone
(509) 932-4499
Fax
(509) 932-5363
NPI assigned
Sep 12, 2024
Last updated
Dec 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2024

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

Authorized official

Name
Dana S Fox
Title
Ceo
Phone
(509) 932-4499

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

206 Government Rd
Mattawa, WA 99349-5116

Mailing address

210 Government Rd
Mattawa, WA 99349-5116
Phone (509) 932-4499

Other names 1

  • Mattawa Community Medical 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
O20040401001562 WA Part B Supplier - Clinic/Group Practice 3274525837 Receives reassigned benefits from 11 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mattawa, WA
O20240710000864 WA Part A Provider - Federally Qualified Health Center (FQHC) 3274525837 1 other NPI on this enrollment
Practice locations: Mattawa, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013743210. Details of each certification follow.

Federally qualified health center certification: CCN 501051

Legal name
GRANT COUNTY PUBLIC HOSPITAL DISTRICT NO 5
Doing business as
MATTAWA COMMUNITY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 21, 2024
Last certification
Mar 21, 2024
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
206 Government Rd
Mattawa, WA 99349-5116

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Grant County Public Hospital District No 54 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Grant County Public Hospital District No 5 Organization, Mattawa, WA Non-profit 5% Or Greater Direct Ownership Interest Nov 1, 2023
Dana Fox Individual Corporate OfficerCeo Aug 1, 2006 100%
W-2 Managing EmployeeCeo Aug 1, 2006 100%
Operational/Managerial ControlCeo Aug 1, 2006 100%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Mattawa Community Medical ClinicMattawa, WA, CCN 501944 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 1, 1984
Mattawa Community Medical ClinicMattawa, WA, CCN 501055 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 16, 2020

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1726099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733270400000",
    "number": "1013743210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 GOVERNMENT RD",
            "city": "MATTAWA",
            "state": "WA",
            "postal_code": "993495116",
            "telephone_number": "509-932-4499",
            "fax_number": "509-932-5363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 GOVERNMENT RD",
            "city": "MATTAWA",
            "state": "WA",
            "postal_code": "993495116",
            "telephone_number": "509-932-4499",
            "fax_number": "509-932-5363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANT COUNTY PUBLIC HOSPITAL DISTRICT NO 5",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-12",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A",
        "authorized_official_last_name": "FOX",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-932-4499"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mattawa Community Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mattawa Community Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mattawa, WA

Sources for this page

Verify at the official NPI Registry.