NPIMap

Organization Active NPI

Chelan County Public Hospital District No 2

Doing business as Express Care Clinic Lake Chelan Health

  • Rural Health Clinic/Center
  • Chelan, WA
National Provider Identifier
1124438312
Registry record updated Apr 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
600071822 Issued in WA
Legal business name
CHELAN COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Doing business as
Express Care Clinic Lake Chelan Health
Practice address
110 S Apple Blossom Dr
Chelan, WA 98816-8810
Phone
(509) 682-3300
Fax
(509) 682-9614
NPI assigned
Apr 28, 2014
Last updated
Apr 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2023

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

Authorized official

Name
Aaron Christopher Edwards
Title
Ceo
Phone
(509) 683-3300

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital Clinic/Center 261QC0050X 600071822 WA
Rural Health Clinic/Center 261QR1300X 600071822 WA Primary

Addresses

Primary practice location

110 S Apple Blossom Dr
Chelan, WA 98816-8810

Mailing address

PO Box 908
Chelan, WA 98816-0908
Phone (509) 682-3300

Other names 1

  • Express Care Clinic Lake Chelan Health Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031226000201 WA Part B Supplier - Clinic/Group Practice 9133027360 Receives reassigned benefits from 160 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chelan, WA
O20140710001062 WA Part A Provider - Rural Health Clinic 9133027360 Practice locations: Chelan, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124438312. Details of each certification follow.

Rural health clinic certification: CCN 508567

Legal name
CHELAN COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Doing business as
EXPRESS CARE LAKE CHELAN HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 1, 2014
Last certification
Oct 10, 2017
Ownership / control type
2A
Most recent change of ownership
Jul 1, 2023 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Apr 30, 1996 in WA
Enrollment address
219 E Johnson Ave
Chelan, WA 98816-9160
Related CCNs
501334

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 4

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D0638086Express Care Lake Chelan Health219 E Johnson Ave, Chelan, WA 98816Certificate of waiverApr 4, 2028
50D2270405Lake Chelan Health110 S Apple Blossom Dr, Chelan, WA 98816ComplianceApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Lake Chelan Comm Hospit15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Locations

110 S Apple Blossom Dr
Chelan, WA 98816
Phone (509) 682-3300

505 E Highland Ave
Chelan, WA 98816
Phone (509) 662-1636

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Victoria Bodle Individual W-2 Managing EmployeeController Aug 23, 2014
Aaron C Edwards Individual Corporate OfficerChief Executive Officer Apr 12, 2022
W-2 Managing EmployeeAd; Apr 12, 2022
Mary Murphy Individual Corporate DirectorBoard Commissioner Jan 1, 2016
Leonard C England Individual Corporate DirectorBoard Commissioner Dec 21, 2023
Ronald Brant Truman Individual Corporate OfficerChief Financial Officer Sep 1, 2022
W-2 Managing EmployeeChief Financial Officer Sep 1, 2022
Shawn Ottley Individual Corporate OfficerChief Operating Officer Nov 11, 2020
W-2 Managing EmployeeChief Operating Officer Nov 11, 2020
Lorijean M Withrow Individual Corporate DirectorBoard Commissioner Jan 1, 2022
Jordana Laporte Individual Corporate DirectorBoard Commissioner May 31, 2018
Chelan County Public Hospital District No 2 Organization, Chelan, WA 5% Or Greater Direct Ownership Interest Sep 1, 2014 100%
Douglas Gibson Individual Corporate DirectorBoard Commissioner Mar 24, 2023
Jodi Sweeney Individual W-2 Managing EmployeeClinic Manager Jan 1, 2019

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Lake Chelan Community HospitalChelan, WA, CCN 501334 Hospital Operational/Managerial Control Jun 6, 2009
Lake Chelan Community HospitalChelan, WA, CCN 50Z334 Hospital Operational/Managerial Control Jun 6, 2009

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 155

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 155

NPI Registry JSON

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

{
    "created_epoch": "1398643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682380800000",
    "number": "1124438312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 908",
            "city": "CHELAN",
            "state": "WA",
            "postal_code": "988160908",
            "telephone_number": "509-682-3300",
            "fax_number": "509-682-9614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 S APPLE BLOSSOM DR",
            "city": "CHELAN",
            "state": "WA",
            "postal_code": "988168810",
            "telephone_number": "509-682-3300",
            "fax_number": "509-682-9614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHELAN COUNTY PUBLIC HOSPITAL DISTRICT NO 2",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-28",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "AARON",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-683-3300"
    },
    "taxonomies": [
        {
            "code": "261QC0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Critical Access Hospital",
            "state": "WA",
            "license": "600071822",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WA",
            "license": "600071822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Express Care Clinic Lake Chelan Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chelan, WA

Sources for this page

Verify at the official NPI Registry.