NPIMap

Organization Active NPI

Jefferson County Public Hospital District No 2

Doing business as Jefferson Healthcare Swingbed

  • Medicare Defined Swing Bed Hospital Unit
  • Port Townsend, WA
National Provider Identifier
1104950039
Registry record updated Oct 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
H085000033 Issued in WA
Legal business name
JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Doing business as
Jefferson Healthcare Swingbed
Practice address
834 Sheridan Ave
Port Townsend, WA 98368-2443
Phone
(360) 385-2200
Fax
(360) 379-4381
NPI assigned
Mar 15, 2007
Last updated
Oct 29, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2020

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

Authorized official

Name
Mike Glenn
Title
Ceo
Phone
(360) 385-2200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X H085000033 WA Primary

Addresses

Primary practice location

834 Sheridan Ave
Port Townsend, WA 98368-2443

Mailing address

834 Sheridan Ave
Port Townsend, WA 98368-2443
Phone (360) 385-2200

Other names 1

  • Jefferson Healthcare Swingbed Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080304000166 WA Part A Provider - Critical Access Hospital 4789593708 Receives reassigned benefits from 177 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Port Townsend, WA
O20121108000438 WA Part A Provider - Critical Access Hospital 4789593708 Practice locations: Port Townsend, WA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1104950039. Details of each certification follow.

Hospital certification: CCN 501323

Legal name
JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Doing business as
JEFFERSON HEALTHCARE
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 1, 2003
Last certification
Apr 15, 2017
Beds
25
Ownership / control type
Hospital district or authority
Organization structure
CorporationProprietary
Incorporated
Jan 1, 1976 in WA
Enrollment address
834 Sheridan St
Port Townsend, WA 98368-2443
Other Hospital Practice Location

Hospital certification: CCN 50Z323

Legal name
JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Doing business as
JEFFERSON HEALTHCARE
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1976 in WA
Enrollment address
834 Sheridan St
Port Townsend, WA 98368-2443
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Jefferson HealthcareCCN 501323 · All quality measures
Overall star rating
3 of 5
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

834 Sheridan St
Port Townsend, WA 98368
Phone (360) 344-0400

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
Bruce McComas Individual Corporate DirectorBoard of Commissioner Jan 1, 2018
Cornelis Kolff Individual Corporate DirectorBoard of Commissioner Jan 1, 2016
Tyler Freeman Individual Corporate OfficerCfo Jan 1, 2022
Operational/Managerial ControlCfo Jan 1, 2022
Brandie Manuel Individual Corporate OfficerChief Patient Care Officer Nov 12, 2020
Corporate DirectorChief Patient Care Officer Nov 12, 2020
Matthew W Ready Individual Corporate DirectorBoard of Commissioner Apr 1, 2014
Corporate DirectorBoard of Commissioners Jefferson Jan 1, 2014
Lawrence M Glenn Individual Corporate OfficerCeo Oct 4, 2010
Corporate DirectorCeo Apr 1, 2014
Operational/Managerial ControlCeo Apr 1, 2014
Operational/Managerial ControlCeo Oct 4, 2010
Jill E Buhler Individual Corporate DirectorBoard of Commissioner Mar 2, 1995
Corporate OfficerCommissioner Mar 2, 1995
Marie L Dressler Individual Corporate DirectorBoard of Commissioner Jan 1, 2010
Corporate OfficerBoard of Commissioners Jefferson Jan 1, 2010

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Jefferson Healthcare Home HealthPort Townsend, WA, CCN 507050 Home health agency Operational/Managerial Control Jan 1, 2003
Jefferson Healthcare Home Health and HospicePort Townsend, WA, CCN 501538 Hospice Operational/Managerial Control Aug 5, 2010

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 399

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

View all 399

NPI Registry JSON

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603929600000",
    "number": "1104950039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "834 SHERIDAN AVE",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983682443",
            "telephone_number": "360-385-2200",
            "fax_number": "360-379-4381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "834 SHERIDAN AVE",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983682443",
            "telephone_number": "360-385-2200",
            "fax_number": "360-379-4381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2020-10-29",
        "certification_date": "2020-10-29",
        "status": "A",
        "authorized_official_last_name": "GLENN",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "360-385-2200"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "WA",
            "license": "H085000033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Healthcare Swingbed",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jefferson Healthcare Swingbed",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Townsend, WA

Sources for this page

Verify at the official NPI Registry.