NPIMap

Organization Active NPI

Grays Harbor Community Hospital

  • Rural Health Clinic/Center
  • Montesano, WA
National Provider Identifier
1083084677
Registry record updated Oct 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GRAYS HARBOR COMMUNITY HOSPITAL
Practice address
319 E Pioneer Ave
Montesano, WA 98563-4601
Phone
(360) 249-3300
NPI assigned
Sep 25, 2015
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Niall Foley
Title
Cfo
Phone
(360) 537-5145

Owners & managing parties with NPI records 4

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

Owned or controlled facilities with NPI records 5

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

Other NPIs on the same Medicare enrollment 11

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

Other NPIs with the same Medicare PAC ID 4

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

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

Facilities with the same owner 3

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

Practitioners 107

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 107

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031231000081 WA Part B Supplier - Clinic/Group Practice 3577462365 Receives reassigned benefits from 213 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Aberdeen, WA; Hoquiam, WA; Montesano, WA; Westport, WA
O20180322001143 WA Part a Provider - Rural Health Clinic 3577462365 Practice locations: Montesano, WA

Rural health clinic certification: CCN 508575

Medicare enrollment files
Legal name
GRAYS HARBOR COMMUNITY HOSPITAL
Doing business as
GHCH MONTESANO CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 16, 2018
Last certification
Jul 31, 2014
Ownership / control type
1B
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1939 in WA
Enrollment address
319 E Pioneer Ave
Montesano, WA 98563-4601
Related CCNs
500031

All disclosed owners & managing parties 3

Medicare enrollment files

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

NameRoleSinceShare
Thomas Jensen Individual Corporate OfficerCeo Apr 16, 2018
W-2 Managing EmployeeCeo Apr 16, 2018
Grays Harbor Community Hospital Organization, Aberdeen, WA Non-profit 5% Or Greater Direct Ownership Interest Apr 16, 2018 100%
Niall Shea Foley Individual Corporate OfficerChief Financial Officer Dec 1, 2018

All facility ownership & control disclosures 3

Medicare enrollment files

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

FacilityTypeRoleSince
Grays Harbor Community HospitalAberdeen, WA, CCN 500031 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jan 1, 2007
Jan 14, 2014
The Hoquiam ClinicHoquiam, WA, CCN 508577 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 16, 2018
GHCH Aberdeen East ClinicAberdeen, WA, CCN 508576 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 16, 2018

National Provider Directory

National Provider Directory
Tax ID family
Urgent Care Clinic10 organizations share this tax ID

Corporate family (same tax ID) 9

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

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

NPPES NPI Registry

Primary practice location

319 E Pioneer Ave
Montesano, WA 98563-4601

Mailing address

915 Anderson Dr
Aberdeen, WA 98520-1006

Other practice location 1

615 N F St
Aberdeen, WA 98520
Phone (360) 533-4599

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
100366800MedicaidWA

Other names 2

NPPES NPI Registry
  • GHCH Aberdeen F Street Clinic Doing business as
  • GHCH Montesano Clinic Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 14, 2019.

{
    "created_epoch": "1443139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571011200000",
    "number": "1083084677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 ANDERSON DR",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985201006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 E PIONEER AVE",
            "city": "MONTESANO",
            "state": "WA",
            "postal_code": "985634601",
            "telephone_number": "360-249-3300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "615 N F St",
            "address_purpose": "LOCATION",
            "city": "Aberdeen",
            "state": "WA",
            "postal_code": "98520",
            "country_code": "US",
            "telephone_number": "360-533-4599",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GRAYS HARBOR COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-25",
        "last_updated": "2019-10-14",
        "status": "A",
        "authorized_official_last_name": "FOLEY",
        "authorized_official_first_name": "NIALL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "360-537-5145"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100366800",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GHCH Aberdeen F Street Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GHCH Aberdeen F Street Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GHCH Montesano Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montesano, WA

Sources for this page

Verify at the official NPI Registry.