NPIMap

Organization Active NPI

Grays Harbor Community Hospital

Doing business as GHCH Hoquiam Clinic

  • Obstetrics & Gynecology Physician
  • Hoquiam, WA
National Provider Identifier
1134597693
Registry record updated Jun 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
GRAYS HARBOR COMMUNITY HOSPITAL
Doing business as
GHCH Hoquiam Clinic
Practice address
815 K St
Hoquiam, WA 98550
Phone
(360) 533-2734
NPI assigned
Sep 14, 2015
Last updated
Jun 5, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2018

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

Authorized official

Name
Antone J Eek
Title
Executive Director Revenue Cylcle
Phone
(360) 581-5495

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X Primary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

815 K St
Hoquiam, WA 98550

Mailing address

915 Anderson Dr
Aberdeen, WA 98520-1006

Other names 1

  • GHCH Hoquiam Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180321002530 WA Part A Provider - Rural Health Clinic 3577462365 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hoquiam, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1134597693. Details of each certification follow.

Rural health clinic certification: CCN 508577

Legal name
GRAYS HARBOR COMMUNITY HOSPITAL
Doing business as
THE HOQUIAM CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 16, 2018
Last certification
Aug 13, 2014
Ownership / control type
1B
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1939 in WA
Enrollment address
815 K St
Hoquiam, WA 98550-3705
Related CCNs
500031

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

1211 Skyview Dr
Aberdeen, WA 98520
Phone (360) 532-3808

1921 Sumner Ave
Aberdeen, WA 98520
Phone (360) 533-6447

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Thomas Jensen Individual Corporate OfficerCeo Apr 16, 2018
W-2 Managing EmployeeCeo Apr 16, 2018
Grays Harbor Community Hospital Organization, Aberdeen, WA Non-profit 5% Or Greater Direct Ownership Interest Apr 16, 2018 100%
Niall Shea Foley Individual Corporate OfficerChief Financial Officer Apr 16, 2018
W-2 Managing Employee Apr 16, 2018

Owners & managing parties with NPI records 5

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

Change-of-ownership history 1

DateEventCounterparty
Apr 16, 2018 Change of OwnershipThis provider was the seller The Hoquiam ClinicCCN 508577, WA, NPI 1376028373

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 42

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 42

NPI Registry JSON

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

{
    "created_epoch": "1442188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528156800000",
    "number": "1134597693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 ANDERSON DR",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985201006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 K ST",
            "city": "HOQUIAM",
            "state": "WA",
            "postal_code": "98550",
            "telephone_number": "360-533-2734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAYS HARBOR COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-14",
        "last_updated": "2018-06-05",
        "status": "A",
        "authorized_official_last_name": "EEK",
        "authorized_official_first_name": "ANTONE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR REVENUE CYLCLE",
        "authorized_official_telephone_number": "360-581-5495"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GHCH Hoquiam Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GHCH Hoquiam Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hoquiam, WA

Sources for this page

Verify at the official NPI Registry.