NPIMap

Organization Active NPI

New Health Programs Association

Doing business as NEW Health Springdale Medical

  • Federally Qualified Health Center (FQHC)
  • Springdale, WA
National Provider Identifier
1104880004
Registry record updated Jul 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
J600317870 Issued in WA
Legal business name
NEW HEALTH PROGRAMS ASSOCIATION
Doing business as
NEW Health Springdale Medical
Practice address
114 S Main
Springdale, WA 99173
Phone
(509) 258-4234
Fax
(509) 258-4499
NPI assigned
Apr 17, 2006
Last updated
Jul 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2023

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

Authorized official

Name
Donna Poe
Title
Credentialing Specialist
Phone
(509) 935-6001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X J600317870 WA Primary

Addresses

Primary practice location

114 S Main
Springdale, WA 99173

Mailing address

PO Box 808
Chewelah, WA 99109-0808
Phone (509) 935-6001

Other names 1

  • NEW Health Springdale Medical Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040119000412 WA Part B Supplier - Clinic/Group Practice 1951202373 Receives reassigned benefits from 30 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Orient, WA; Springdale, WA; Northport, WA; Nine Mile Falls, WA; Newport, WA; Loon Lake, WA; Ione, WA; Colville, WA…
O20120316000349 WA Part A Provider - Federally Qualified Health Center (FQHC) 1951202373 Practice locations: Springdale, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104880004. Details of each certification follow.

Federally qualified health center certification: CCN 501808

Legal name
NEW HEALTH PROGRAMS ASSOCIATION
Doing business as
SPRINGDALE COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 20, 1978 in WA
Enrollment address
114S Main St
Springdale, WA 99173-9740
Related CCNs
507044

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

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

Locations

518 E Clay Ave
#808
Chewelah, WA 99109

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
Malcolm Friedman Individual Corporate OfficerTreasurer Nov 10, 2016
Carolyn G Renz Individual Corporate Director Sep 12, 2013
Katie Weythman Individual Corporate DirectorDirector Aug 9, 2018
Judith a Regis Individual Corporate Director Apr 14, 2016
Alison McGrane Individual Corporate OfficerChairperson Dec 1, 2017
Frank M Moore Individual Corporate Director May 8, 2008
Carmen Ann Deal Individual Corporate Director Nov 14, 2013
Dale Storer Individual Corporate Director May 12, 2016
Deloris Henry Individual Corporate Director Jan 9, 2014
Margaret E Dickinson Individual Corporate OfficerSecretary Jun 14, 1992
Desiree L Sweeney Individual Corporate OfficerChief Executive Officer Oct 2, 2012
W-2 Managing EmployeeChief Executive Officer Oct 1, 2012
Ken Rozelle Individual Corporate DirectorDirector May 10, 2018
Don W Renz Individual Corporate Director Feb 12, 2009

Practitioners & affiliated clinicians

Practitioners 41

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.

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1145232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689638400000",
    "number": "1104880004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 808",
            "city": "CHEWELAH",
            "state": "WA",
            "postal_code": "991090808",
            "telephone_number": "509-935-6001",
            "fax_number": "509-935-4196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 S MAIN",
            "city": "SPRINGDALE",
            "state": "WA",
            "postal_code": "99173",
            "telephone_number": "509-258-4234",
            "fax_number": "509-258-4499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW HEALTH PROGRAMS ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-17",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A",
        "authorized_official_last_name": "POE",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "509-935-6001"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WA",
            "license": "J600317870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NEW Health Springdale Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springdale, WA

Sources for this page

Verify at the official NPI Registry.