Sunnyside Community Hospital

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD00035449 Issued in WA

Legal business name

SUNNYSIDE COMMUNITY HOSPITAL

Practice address

812 Miller Ave Ste C
Sunnyside, WA 98944-2377

Phone

(509) 837-7551

Fax

(509) 837-6341

NPI assigned

May 20, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Mathew Mathiesen

Title

Cfo

Phone

(509) 837-1655

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043477813. Details of each certification follow.

• CCN 508547 Rural health clinic · Active · Details

Rural health clinic certification: CCN 508547

Legal name

SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION

Doing business as

ASTRIA HEALTH CENTER

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Sep 25, 2008

Last certification

May 13, 2015

Ownership / control type

2B

Organization structure

CorporationNon-profit

Enrollment address

803 E Lincoln Ave
Sunnyside, WA 98944-2383

Related CCNs

501330

Related certifications (CCN) 1

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

• Sunnyside Community Hospital Association

  dba Astria Sunnyside Hospital

  • Critical Access Hospital
  • Sunnyside, WA
  • NPI 1225033814

  Parent provider

  Provider of Services

Other NPIs on the same Medicare enrollment 1

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

• Sunnyside Community Hospital Association

  dba Astria Health Center

  • Rural Health Clinic/Center
  • Sunnyside, WA
  • NPI 1467464396

  O20080721000510

  Same enrollment

All disclosed owners & managing parties 9

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

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

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728518400000",
    "number": "1043477813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 719",
            "city": "SUNNYSIDE",
            "state": "WA",
            "postal_code": "989440719",
            "telephone_number": "509-837-7551",
            "fax_number": "509-837-6341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 MILLER AVE STE C",
            "city": "SUNNYSIDE",
            "state": "WA",
            "postal_code": "989442377",
            "telephone_number": "509-837-7551",
            "fax_number": "509-837-6341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNNYSIDE COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-20",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A",
        "authorized_official_last_name": "MATHIESEN",
        "authorized_official_first_name": "MATHEW",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "509-837-1655",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00035449",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James E Stevens, DR MEDICAL DENTISTRY
• Kristian L Stewart, CDPT
• Carla Sue Stoops, COTA/L
• Demetrius Straws
• Sunnyside Chiropractic Centre P S
• Sunnyside Community Hospital (Sunnyside ENT, Sunnyside Bone and Joint)
• Sunnyside Community Hospital
• Sunnyside Community Hospital (Valley Regional Bone and Joint)
• Sunnyside Community Hospital Assocation (Sunnyside Surgical Associates)
• Sunnyside Community Hospital Association (Astria Sunnyside Hospital)

• Pediatrics Physician in Sunnyside, WA
• Providers in Sunnyside, WA by specialty
• Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.