NPIMap

Organization Active NPI

Community Health of Central Washington

Doing business as Yakima Pediatrics

  • Pediatrics Physician
  • Yakima, WA
National Provider Identifier
1154533222
Registry record updated Jul 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
COMMUNITY HEALTH OF CENTRAL WASHINGTON
Doing business as
Yakima Pediatrics
Practice address
402 S 12TH Ave
Yakima, WA 98902-3115
Phone
(509) 575-0114
Fax
(509) 575-0808
NPI assigned
May 3, 2007
Last updated
Jul 29, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2020

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

Authorized official

Name
Miss Angela Gonzalez
Title
Ceo
Phone
(509) 494-6700

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary
Federally Qualified Health Center (FQHC) 261QF0400X

Addresses

Primary practice location

402 S 12TH Ave
Yakima, WA 98902-3115

Mailing address

501 S 5TH Ave
Yakima, WA 98902-3550
Phone (509) 494-6700

Other names 1

  • Yakima Pediatrics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070606000466 WA Part A Provider - Federally Qualified Health Center (FQHC) 4183536931 1 other NPI on this enrollment
Practice locations: Yakima, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154533222. Details of each certification follow.

Federally qualified health center certification: CCN 501904

Legal name
COMMUNITY HEALTH OF CENTRAL WASHINGTON
Doing business as
YAKIMA PEDIATRICS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 26, 2007
Last certification
Jul 26, 2007
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Sep 11, 1992 in WA
Enrollment address
402 S 12TH Ave
Yakima, WA 98902-3115

Other NPIs with the same Medicare PAC ID 6

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

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
Tax ID family
Community Health of Central14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

521 E Mountain View Ave
Ellensburg, WA 98926
Phone (509) 962-1414

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Earl Curtis Weatherman Individual Corporate Director Jan 1, 2006
James Michael Boutillier Individual Corporate Director Jan 1, 2006
Lisa Martin Individual W-2 Managing Employee Jan 1, 2006
Joseph Lee Vickers Individual Corporate Director Jan 1, 2006
Elizabeth Herres Miller Individual Corporate Director Jan 1, 2006
Angela Gonzalez Individual Corporate Officer Aug 19, 2019 100%
W-2 Managing EmployeeCeo Aug 19, 2019 100%
Desiree Ashbrooks Individual Corporate OfficerCfo Sep 1, 2021
Corporate DirectorCfo Sep 1, 2021
W-2 Managing EmployeeCfo Apr 24, 2008

Practitioners & affiliated clinicians

Practitioners 44

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 44

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595980800000",
    "number": "1154533222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S 5TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023550",
            "telephone_number": "509-494-6700",
            "fax_number": "509-573-6275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 S 12TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023115",
            "telephone_number": "509-575-0114",
            "fax_number": "509-575-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH OF CENTRAL WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-494-6700",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Yakima Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yakima, WA

Sources for this page

Verify at the official NPI Registry.