NPIMap

Organization Active NPI

Sunnyside Community Hospital

Doing business as Sunnyside ENT, Sunnyside Bone and Joint

  • Otolaryngology Physician
  • Sunnyside, WA
National Provider Identifier
1083866040
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
MD60030905 Issued in WA
Legal business name
SUNNYSIDE COMMUNITY HOSPITAL
Doing business as
Sunnyside ENT, Sunnyside Bone and Joint
Practice address
2925 Allen Rd
Sunnyside, WA 98944-8931
Phone
(509) 837-1617
Fax
(509) 837-1714
NPI assigned
Oct 21, 2008
Last updated
Oct 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2024

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

Authorized official

Name
Mathew Mathiesen
Title
Cfo
Phone
(509) 837-1617

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X MD60307626 WA
Otolaryngology Physician 207Y00000X MD60030905 WA Primary

Addresses

Primary practice location

2925 Allen Rd
Sunnyside, WA 98944-8931

Mailing address

PO Box 719
Sunnyside, WA 98944-0719
Phone (509) 837-1617

Other identifiers 2

IdentifierTypeStateIssuer
8527194MedicaidWA
7144421MedicaidWA

Other names 1

  • SUNNYSIDE ENT, SUNNYSIDE BONE AND JOINT Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040227000194 WA Part B Supplier - Clinic/Group Practice 1658280896 Receives reassigned benefits from 139 practitioners
30 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Zillah, WA; Yakima, WA; Union Gap, WA; Toppenish, WA; Sunnyside, WA; Prosser, WA; Grandview, WA

Other NPIs on the same Medicare enrollment 30

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

View all 30

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1224547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728518400000",
    "number": "1083866040",
    "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": "509-837-1617",
            "fax_number": "509-837-1714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2925 ALLEN RD",
            "city": "SUNNYSIDE",
            "state": "WA",
            "postal_code": "989448931",
            "telephone_number": "509-837-1617",
            "fax_number": "509-837-1714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNNYSIDE COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-21",
        "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": "509-837-1617"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WA",
            "license": "MD60307626",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "WA",
            "license": "MD60030905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8527194",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7144421",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUNNYSIDE ENT, SUNNYSIDE BONE AND JOINT",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SUNNYSIDE ENT, SUNNYSIDE BONE AND JOINT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sunnyside, WA

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.