NPIMap

Organization Active NPI

Lincoln County Hospital District #3 / North Basin Medical Clinics

Doing business as North Basin Medical Clinics

  • Family Medicine Physician
  • Davenport, WA
National Provider Identifier
1053527853
Registry record updated Jun 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LINCOLN COUNTY HOSPITAL DISTRICT #3 / NORTH BASIN MEDICAL CLINICS
Doing business as
North Basin Medical Clinics
Practice address
10 Nicholls St
Davenport, WA 99122-9729
Phone
(509) 725-7501
Fax
(509) 725-7504
NPI assigned
May 16, 2007
Last updated
Jun 8, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
LINCOLN COUNTY HOSPITAL DISTRICT 3As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 8, 2026

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

Authorized official

Name
Tyson E Lacy
Title
Ceo
Phone
(509) 725-2979

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Surgery Physician 208600000X

Addresses

Primary practice location

10 Nicholls St
Davenport, WA 99122-9729

Mailing address

10 Nicholls St
Davenport, WA 99122-9729
Phone (509) 725-7501

Other identifiers 3

IdentifierTypeStateIssuer
CJ6525OtherWAMEDICARE RAILROAD
7101132MedicaidWA
7117450MedicaidWA

Other names 1

  • North Basin Medical Clinics Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040505000483 WA Part B Supplier - Clinic/Group Practice 3971591199 Receives reassigned benefits from 21 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Davenport, WA
O20080512000261 WA Part A Provider - Rural Health Clinic 3971591199 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Davenport, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053527853. Details of each certification follow.

Rural health clinic certification: CCN 508529

Legal name
LINCOLN COUNTY HOSPITAL DISTRICT 3
Doing business as
NORTH BASIN MEDICAL CLINICS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 1, 2003
Last certification
Dec 28, 2015
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1962 in WA
Enrollment address
10 Nicholls St
Davenport, WA 99122-9729
Related CCNs
501305

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Part of
Reardan Health Clinic

Locations

100 3rd St
Ste 1
Davenport, WA 99122
Phone (509) 725-7501

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Herschell Smith Individual Corporate DirectorDirector Jan 1, 2019
Rox a Sherwood Individual Corporate DirectorBoard Member Jun 5, 2006
Jennifer Larmer Individual Corporate OfficerChief Patient Services Officer Feb 1, 2011
Lincoln County Hospital District 3 Organization, Davenport, WA Operational/Managerial Control Oct 23, 2007
Tyson Lacy Individual Corporate OfficerCeo/Coo Feb 16, 2016
Andrew Schrek Individual Corporate DirectorDirector Feb 1, 2021
Darci Linstrum Individual W-2 Managing Employee Jan 1, 2007

Owners & managing parties with NPI records 5

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 12

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": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780876800000",
    "number": "1053527853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 NICHOLLS ST",
            "city": "DAVENPORT",
            "state": "WA",
            "postal_code": "991229729",
            "telephone_number": "509-725-7501",
            "fax_number": "509-725-7504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 NICHOLLS ST",
            "city": "DAVENPORT",
            "state": "WA",
            "postal_code": "991229729",
            "telephone_number": "509-725-7501",
            "fax_number": "509-725-7504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLN COUNTY HOSPITAL DISTRICT #3 / NORTH BASIN MEDICAL CLINICS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LINCOLN COUNTY HOSPITAL DISTRICT 3",
        "enumeration_date": "2007-05-16",
        "last_updated": "2026-06-08",
        "certification_date": "2026-06-08",
        "status": "A",
        "authorized_official_last_name": "LACY",
        "authorized_official_first_name": "TYSON",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-725-2979"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CJ6525",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7101132",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7117450",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Basin Medical Clinics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "North Basin Medical Clinics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Davenport, WA

Sources for this page

Verify at the official NPI Registry.