NPIMap

Organization Active NPI

Public Hospital District No 1 of Mason County

  • Family Medicine Physician
  • Shelton, WA
National Provider Identifier
1134573272
Registry record updated Apr 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PUBLIC HOSPITAL DISTRICT NO 1 OF MASON COUNTY
Practice address
1812 N 13TH Loop Rd
Shelton, WA 98584-2169
Phone
(360) 426-3862
NPI assigned
Apr 14, 2016
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mr. Eric Moll
Title
Chief Executive Officer
Phone
(360) 427-9556

Other NPIs on the same Medicare enrollment 10

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

Corporate family (same tax ID) 17

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

Practitioners 22

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

Medicare participation

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

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20040310001481 WA Part B Supplier - Clinic/Group Practice 0345139275 Receives reassigned benefits from 180 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Shelton, WA; Olympia, WA; Hoodsport, WA

National Provider Directory

National Provider Directory
Tax ID family
Public Hospital District No (18 organizations share this tax ID)

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X Primary
Foot & Ankle Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X

Addresses

NPPES NPI Registry

Primary practice location

1812 N 13TH Loop Rd
Shelton, WA 98584-2169

Mailing address

1812 N 13TH Loop Rd
Shelton, WA 98584-2169

Other names 1

NPPES NPI Registry
  • MGH Family Health, Ankle and Foot Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 14, 2017.

{
    "created_epoch": "1460592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492128000000",
    "number": "1134573272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1812 N 13TH LOOP RD",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985842169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1812 N 13TH LOOP RD",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985842169",
            "telephone_number": "360-426-3862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HOSPITAL DISTRICT NO 1 OF MASON COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-14",
        "last_updated": "2017-04-14",
        "status": "A",
        "authorized_official_last_name": "MOLL",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "360-427-9556",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MGH Family Health, Ankle and Foot",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shelton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.