NPIMap

Organization Active NPI

Klickitat County Public Hospital District No1

Doing business as Klickitat Valley Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Goldendale, WA
National Provider Identifier
1093879975
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
KLICKITAT COUNTY PUBLIC HOSPITAL DISTRICT NO1
Doing business as
Klickitat Valley Hospital
Practice address
310 S Roosevelt Ave
Goldendale, WA 98620-9201
Phone
(509) 773-4022
Fax
(509) 773-1941
NPI assigned
Dec 21, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Sharon Cox
Title
Ceo
Phone
(509) 773-4022

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X WA Primary

Addresses

Primary practice location

310 S Roosevelt Ave
Goldendale, WA 98620-9201

Mailing address

310 S Roosevelt Ave
Goldendale, WA 98620-9201
Phone (509) 773-4022

Other names 1

  • KLICKITAT VALLEY HOSPITAL Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070402000635 WA Part A Provider - Critical Access Hospital 0648164269 Receives reassigned benefits from 7 practitioners
Practice locations: Goldendale, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093879975. Details of each certification follow.

Hospital certification: CCN 50Z316

Legal name
KLICKITAT COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Doing business as
KLICKITAT VALLEY HEALTH
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1941 in WA
Enrollment address
310 S Roosevelt St
Goldendale, WA 98620-9201
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Klickitat County Public7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Larry Hoctor Individual Corporate Director Jan 15, 2020
Ronald Ihrig Individual Corporate Director Jan 3, 2022
Jonathan Hatfield Individual Corporate OfficerCeo Oct 7, 2023
W-2 Managing Employee Jun 6, 2005
Mary Pond Individual Corporate Director Jan 1, 2014
Crystal Scott Individual Corporate Director May 1, 2019
Mark Sigfrinius Individual Corporate Director Jan 1, 2014
Jamie L Slater Individual W-2 Managing EmployeeController Apr 20, 1976
Lori Groves Individual Corporate OfficerCfo Dec 1, 2020
W-2 Managing Employee Dec 1, 2020

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Klickitat Valley HealthGoldendale, WA, CCN 501539 Hospice Operational/Managerial Control Apr 4, 2005
KVH Family MedicineGoldendale, WA, CCN 508519 Rural health clinic Operational/Managerial Control Jan 1, 1986

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 8

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.

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093879975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 S ROOSEVELT AVE",
            "city": "GOLDENDALE",
            "state": "WA",
            "postal_code": "986209201",
            "telephone_number": "509-773-4022",
            "fax_number": "509-773-1941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 S ROOSEVELT AVE",
            "city": "GOLDENDALE",
            "state": "WA",
            "postal_code": "986209201",
            "telephone_number": "509-773-4022",
            "fax_number": "509-773-1941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KLICKITAT COUNTY PUBLIC HOSPITAL DISTRICT NO1",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COX",
        "authorized_official_first_name": "SHARON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-773-4022"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KLICKITAT VALLEY HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Goldendale, WA

Sources for this page

Verify at the official NPI Registry.