NPIMap

Organization Active NPI

Columbia Basin Health Association

Doing business as Wahluke Clinic

  • Federally Qualified Health Center (FQHC)
  • Mattawa, WA
National Provider Identifier
1053539890
Registry record updated Jul 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COLUMBIA BASIN HEALTH ASSOCIATION
Doing business as
Wahluke Clinic
Practice address
601 Government Way
Mattawa, WA 99349
Phone
(509) 932-3535
Fax
(509) 488-9939
NPI assigned
Apr 24, 2007
Last updated
Jul 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2023

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

Authorized official

Name
Joshua Bunch
Title
Cfo
Phone
(509) 488-5250

Specialties & licenses 1

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

Addresses

Primary practice location

601 Government Way
Mattawa, WA 99349

Mailing address

1515 E Columbia St
Othello, WA 99344-1846
Phone (509) 488-5256

Other identifiers 7

IdentifierTypeStateIssuer
7096555MedicaidWA
0135012OtherWADEPT OF L&I
7107675OtherWAUGS MDC DSHS CROSSOVER
7407927MedicaidWA
7900624OtherWATAKE CHARGE #
8908941OtherWACRIME VICTIMS #
50D9963406OtherWACLIA #

Other names 1

  • Wahluke Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040427000342 WA Part A Provider - Federally Qualified Health Center (FQHC) 4486564309 Practice locations: Mattawa, WA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1053539890. Details of each certification follow.

Federally qualified health center certification: CCN 501877

Legal name
COLUMBIA BASIN HEALTH ASSOCIATION
Doing business as
WAHLUKE FAMILY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 17, 2004
Last certification
May 17, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 26, 1973 in WA
Enrollment address
601 Government Way
Mattawa, WA 99349-9500

Federally qualified health center certification: CCN 501853

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
WAHLUKE FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 13, 1999
Last certification
Nov 13, 1999
Ownership / control type
For profit – partnership
Facility address
601 Government Way
Mattawa, WA 99349

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Columbia Basin Health17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Joshua Bunch Individual Corporate OfficerVP of Finance Mar 1, 2018
Deborah Buss Individual Corporate DirectorBoard Member Feb 26, 2013
Maria Quezada Individual Corporate DirectorBoard Member Mar 28, 2017
Martha Holt Individual Corporate DirectorBoard Member Apr 19, 2017
Nieves Gomez Individual Contracted Managing EmployeeCeo Mar 1, 2019 100%
5% Or Greater Direct Ownership InterestCeo Mar 1, 2018 100%
Corporate DirectorCeo Mar 1, 2018 100%
W-2 Managing EmployeeCeo Mar 1, 2018 100%
Operational/Managerial ControlCeo Mar 1, 2019 100%
Joe Montemayor Individual Corporate DirectorChairman Apr 1, 2001
Dora Beraza Individual Corporate DirectorBoard Member Sep 30, 2010
Enrique Miron Individual Corporate DirectorBoard Member Apr 3, 2006
Marisol Quezada Individual Corporate DirectorBoard Secretary Jan 31, 2023
Mike Garza Individual Corporate DirectorEmeritus Member Sep 30, 2010
Maria Rosales Individual Corporate DirectorBoard Member May 27, 2014
Scott Harris Individual Corporate DirectorVice Chair May 28, 2019
Martin Gallardo Individual Corporate DirectorBoard Member Sep 30, 2010

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Columbia Basin Health AssociationPasco, WA, CCN 501042 Federally qualified health center Operational/Managerial Control (100%) Mar 18, 2018

Owned or controlled facilities with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689033600000",
    "number": "1053539890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 E COLUMBIA ST",
            "city": "OTHELLO",
            "state": "WA",
            "postal_code": "993441846",
            "telephone_number": "509-488-5256",
            "fax_number": "509-488-9939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 GOVERNMENT WAY",
            "city": "MATTAWA",
            "state": "WA",
            "postal_code": "99349",
            "telephone_number": "509-932-3535",
            "fax_number": "509-488-9939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA BASIN HEALTH ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A",
        "authorized_official_last_name": "BUNCH",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "509-488-5250"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7096555",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF L&I",
            "identifier": "0135012",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UGS MDC DSHS CROSSOVER",
            "identifier": "7107675",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7407927",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAKE CHARGE #",
            "identifier": "7900624",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRIME VICTIMS #",
            "identifier": "8908941",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA #",
            "identifier": "50D9963406",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wahluke Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mattawa, WA

Sources for this page

Verify at the official NPI Registry.