NPIMap

Organization Active NPI

Jamestown S'Klallam Tribe

Doing business as Jamestown Healing Clinic

  • Federally Qualified Health Center (FQHC)
  • Sequim, WA
National Provider Identifier
1023195161
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
JAMESTOWN S'KLALLAM TRIBE
Doing business as
Jamestown Healing Clinic
Practice address
526 S 9TH Ave
Sequim, WA 98382-3626
Phone
(360) 681-7755
Fax
(360) 681-5999
NPI assigned
Nov 1, 2006
Last updated
Nov 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

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

Authorized official

Name
W. Ron Allen
Title
Tribal Chairman/Executive Director
Phone
(360) 683-1109

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Family Medicine Physician 207Q00000X
Public Health & General Preventive Medicine Physician 2083P0901X
General Practice Physician 208D00000X

Addresses

Primary practice location

526 S 9TH Ave
Sequim, WA 98382-3626

Mailing address

526 S 9TH Ave
Sequim, WA 98382-3626
Phone (360) 681-7755

Other identifiers 1

IdentifierTypeStateIssuer
1991355MedicaidWA

Other names 1

  • Jamestown Healing 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
O20050507000057 WA Part B Supplier - Clinic/Group Practice 2365349495 Receives reassigned benefits from 45 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sequim, WA
O20230315002781 WA Part A Provider - Federally Qualified Health Center (FQHC) 2365349495 Practice locations: Sequim, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023195161. Details of each certification follow.

Federally qualified health center certification: CCN 501021

Legal name
JAMESTOWN S'KLALLAM TRIBE
Doing business as
JAMESTOWN HEALING CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 13, 2022
Last certification
Oct 13, 2022
Ownership / control type
For profit – corporation
Organization structure
GovernmentProprietary
Enrollment address
526 S 9TH Ave
Sequim, WA 98382-3626

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Jamestown S'Klallam Tribe Organization, Sequim, WA 5% Or Greater Direct Ownership Interest May 17, 2010
Diane M Gange Individual Corporate OfficerCfo Apr 1, 2010
Cindy Lowe Individual Corporate DirectorDeputy Director of Health Jan 1, 2010
William Allen Individual Corporate OfficerTribal Chairman/Chief Executive Off May 17, 2010
W-2 Managing Employee May 17, 2010

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Jamestown Family Health ClinicSequim, WA, CCN 501872 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 17, 2010

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 26

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 26

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731283200000",
    "number": "1023195161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 S 9TH AVE",
            "city": "SEQUIM",
            "state": "WA",
            "postal_code": "983823626",
            "telephone_number": "360-681-7755",
            "fax_number": "360-681-5999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 S 9TH AVE",
            "city": "SEQUIM",
            "state": "WA",
            "postal_code": "983823626",
            "telephone_number": "360-681-7755",
            "fax_number": "360-681-5999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMESTOWN S'KLALLAM TRIBE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "W.",
        "authorized_official_middle_name": "RON",
        "authorized_official_title_or_position": "TRIBAL CHAIRMAN/EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "360-683-1109"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1991355",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jamestown Healing Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sequim, WA

Sources for this page

Verify at the official NPI Registry.