Enumclaw Regional Hospital Association
Organization Active NPI Critical Access Hospital · Enumclaw, WA
NPI 1073674040 · NPPES record last updated Jan 23, 2017
Key facts
- NPI
- 1073674040
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- License
- H035 (WA)
- Legal business name
- ENUMCLAW REGIONAL HOSPITAL ASSOCIATION
- Practice address
- 1455 Battersby Ave
Enumclaw, WA 98022-3634 - Phone
- (360) 802-3265
- Fax
- (360) 825-9046
- NPI assigned
- Dec 13, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Mike Fitzgerald
- Title
- Cfo
- Phone
- (253) 680-4005
Owners & managing parties with NPI records 7
-
Gregg Stephen Meyer, M.D.
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Member of 1
Related certifications (CCN) 1
Facilities with the same owner 10
Practitioners 23
-
Stormy Dupree, ARNP, CNM
-
Jun-Beom Kwon, MD
-
Yongqing Li, MD
-
Joseph Magley, MD
-
Gabrielle N Parker, CNM, ARNP
-
Hrishikesh Raut, M.D.
-
Karen E Robinson, MD
-
Paweena Thoophom, M.D.
-
Edward E Weng, MD
-
Kevin Yi, MD
-
Rikki Desiree Baldwin, D.O.
-
Marcelina Behnam-Curry, M.D.
-
Arjun Chandrasekaran, M.D.
-
Mai VI Ha Hoang, MD
-
Megan Ly Leung, M.D
-
Lia Marie Borja Sabalo, M.D.
-
John Marshall Strong, M.D.
-
James Jerome Zimmerman, M.D.
Affiliated clinicians 102
-
Patrick Nephi Bacon, M.D.
-
Melissa K Barney, MD
-
Dane Bay, M.D., M.P.H.
-
Andrey Bobrovnikov, CRNA
-
Jefferson L Boulet, PAC
-
Racquel Smith Bueno, M.D.
-
Christopher Christiansen, M.D.
-
James T Clemen, MD
-
Desiree Clement, MD
-
Daniel T Clerc, MD
-
Randal Curtis Cupp, PA-C
-
Todd L Davidson, MD
-
Kristopher S. Dunbrack, M.D.
-
Michael Adel Eskander, M.D.
-
Joy Yea Frey, ARNP
-
Lei Gao, MD
-
Yuehua Gao, MD
-
Mark D Garcia, D.O.
Medicare Care Compare: Hospital
- Listed as
- St Elizabeth Hospital
- Overall star rating
- ★★★★★ 5 of 5
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MA
Hospital certification: CCN 501335
- Legal name
- ENUMCLAW REGIONAL HOSPITAL ASSOCIATION
- Doing business as
- ST ELIZABETH HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Nov 1, 2004
- Last certification
- Feb 24, 2023
- Beds
- 28 (5 certified)
- Ownership / control type
- Private (not for profit)
- Most recent change of ownership
- May 1, 2007 (1 total)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 1, 1947 in WA
- Enrollment address
- 1455 Battersby Ave
St Elizabeth Hospital
Enumclaw, WA 98022-3634
Hospital certification: CCN 50Z335
- Legal name
- ENUMCLAW REGIONAL HOSPITAL ASSOCIATION
- Doing business as
- ST ELIZABETH HOSPITAL
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 1, 1947 in WA
- Enrollment address
- 1455 Battersby Ave
St Elizabeth Hospital
Enumclaw, WA 98022-3634
All disclosed owners & managing parties 18
| Name | Role | Since | Share |
|---|---|---|---|
| Robert Carlile |
Corporate Director | Jan 1, 2021 | |
| Diann E Puls |
Corporate Director | Jul 1, 2011 | |
| Marvin O'Quinn |
Corporate Director | Jan 1, 2021 | |
| Uli Han-Hsiang CHI |
Corporate Director | Apr 1, 2013 | |
| Gregg S Meyer |
Corporate Director | Jan 1, 2021 | |
| Franciscan Health System |
5% Or Greater Direct Ownership Interest | May 7, 2007 | |
| Operational/Managerial Control | May 7, 2007 | ||
| 5% Or Greater Direct Ownership Interest | May 1, 2007 | ||
| Operational/Managerial Control | May 1, 2007 | ||
| Robert Lemon |
Corporate Director | Jan 1, 2021 | |
| David Nosacka |
Corporate Officer |
Jul 5, 2021 | |
| W-2 Managing Employee |
Jul 5, 2021 | ||
| Corporate Director |
Jul 5, 2021 | ||
| Catholic Health Initiatives |
5% Or Greater Direct Ownership Interest | May 7, 2007 | |
| 5% Or Greater Direct Ownership Interest | May 1, 2007 | ||
| Karen T Lee |
Corporate Director | Jan 1, 2021 | |
| John F Oppenheimer |
Corporate Director | Jan 1, 2021 | |
| David Butcherite |
W-2 Managing Employee |
Jul 1, 2004 | |
| Carolyn Corvi |
Corporate Director | Jan 1, 2021 | |
| Ketul J Patel |
Corporate Officer | Feb 23, 2015 | |
| W-2 Managing Employee |
Feb 23, 2015 | ||
| W-2 Managing Employee | Feb 23, 2015 | ||
| Michael a Hoffman |
Corporate Director | Jul 1, 2012 | |
| Ruth Elizabeth Goodwin |
Corporate Director | Jan 1, 2021 | |
| Dennis Joseph Hunthausen |
Corporate Director | Jul 1, 2012 | |
| Tod Hamachek |
Corporate Director | Jan 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080515000367 | MA | Part a Provider - Critical Access Hospital | 4385532738 | Practice locations: Enumclaw, WA |
| O20080515000423 | MA | Part a Provider - Critical Access Hospital | 4385532738 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Enumclaw, WA |
National Provider Directory
Locations
6870 S Rainbow Blvd
Ste 107
Las Vegas, NV 89118
Phone (702) 396-6000
1450 Battersby Ave
Enumclaw, WA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | H035 | WA | Yes |
Addresses
Primary practice location
1455 Battersby Ave
Enumclaw, WA 98022-3634
Mailing address
PO Box 31001-1482
Pasadena, CA 91110-1482
Phone (360) 802-3265
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3310406 | Medicaid | WA |
Other names
- St. Elizabeth Hospital
Other providers in Enumclaw, WA
- Enumclaw Family Chiropractic PLLC
- Enumclaw Family Optometry Clinic PS
- Enumclaw Fire Department
- Enumclaw Internal Medicine and Diagnostics, PS
- Enumclaw Radiologists PLLC
- Enumclaw Regional Hospital Association
- Enumclaw Regional Hospital Association
- Enumclaw School District
- Enumclaw SNF Operations, LLC
- Enumclaw Vision Clinic PLLC
All providers in Enumclaw, WA · Critical Access Hospital in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 23, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.