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Jefferson County Public Hospital District No 2

Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Port Townsend, WA

NPI 1104950039 · NPPES record last updated Oct 29, 2020

Key facts

NPI
1104950039
Entity type
Organization (NPI type 2)
Primary specialty
Medicare Defined Swing Bed Hospital Unit 275N00000X
License
H085000033 (WA)
Legal business name
JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Practice address
834 Sheridan Ave
Port Townsend, WA 98368-2443
Phone
(360) 385-2200
Fax
(360) 379-4381
NPI assigned
Mar 15, 2007
Organization subpart
No

Authorized official

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

Owned or controlled facilities with NPI records 1

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

Other NPIs on the same Medicare enrollment 2

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

Other NPIs with the same Medicare PAC ID 9

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

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

Practitioners 151

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

View all 151

Affiliated clinicians 399

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

View all 399

Medicare Care Compare: Hospital

Listed as
Jefferson Healthcare CCN 501323
Overall star rating
★★★☆☆ 3 of 5
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in WA

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
Corporation · Proprietary
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
Corporation · Non-profit
Incorporated
Jan 1, 1976 in WA
Enrollment address
834 Sheridan St
Port Townsend, WA 98368-2443
Other Hospital Practice Location

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 Director
Board of Commissioner		 Jan 1, 2018
Cornelis Kolff
Individual 		Corporate Director
Board of Commissioner		 Jan 1, 2016
Tyler Freeman
Individual 		Corporate Officer
Cfo		 Jan 1, 2022
Operational/Managerial Control
Cfo		 Jan 1, 2022
Brandie Manuel
Individual 		Corporate Officer
Chief Patient Care Officer		 Nov 12, 2020
Corporate Director
Chief Patient Care Officer		 Nov 12, 2020
Matthew W Ready
Individual 		Corporate Director
Board of Commissioner		 Apr 1, 2014
Corporate Director
Board of Commissioners Jefferson		 Jan 1, 2014
Lawrence M Glenn
Individual 		Corporate Officer
Ceo		 Oct 4, 2010
Corporate Director
Ceo		 Apr 1, 2014
Operational/Managerial Control
Ceo		 Apr 1, 2014
Operational/Managerial Control
Ceo		 Oct 4, 2010
Jill E Buhler
Individual 		Corporate Director
Board of Commissioner		 Mar 2, 1995
Corporate Officer
Commissioner		 Mar 2, 1995
Marie L Dressler
Individual 		Corporate Director
Board of Commissioner		 Jan 1, 2010
Corporate Officer
Board 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 Health
Port Townsend, WA · CCN 507050		 Home health agency Operational/Managerial Control Jan 1, 2003
Jefferson Healthcare Home Health and Hospice
Port Townsend, WA · CCN 501538		 Hospice Operational/Managerial Control Aug 5, 2010

Medicare enrollment records

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

National Provider Directory

Specialties & licenses

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

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

  • Jefferson Healthcare Swingbed Doing business as

Other providers in Port Townsend, WA

All providers in Port Townsend, WA · Medicare Defined Swing Bed Hospital Unit in Washington

Sources for this page

Verify at the official NPI Registry.