NPIMap

Organization Active NPI

Whidbey Island Public Hospital District

  • Rural Health Clinic/Center
  • Freeland, WA
National Provider Identifier
1164934188
Registry record updated Jul 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT
Practice address
5486 Harbor Ave
Freeland, WA 98249-3002
Phone
(360) 331-5060
Fax
(360) 331-2104
NPI assigned
Oct 31, 2017
Last updated
Jul 20, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 20, 2023

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

Authorized official

Name
Garth A MillerNPI 1801082102
Title
Coo
Phone
(360) 678-7656

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

5486 Harbor Ave
Freeland, WA 98249-3002

Mailing address

PO Box 462
Freeland, WA 98249-0462
Phone (360) 331-5060

Other names 1

  • WhidbeyHealth Primary Care - Freeland Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171129002936 WA Part A Provider - Rural Health Clinic 1658280680 Practice locations: Freeland, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164934188. Details of each certification follow.

Rural health clinic certification: CCN 508585

Legal name
WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT
Doing business as
WHIDBEYHEALTH PRIMARY CARE - FREELAND
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 21, 2018
Last certification
Dec 21, 2018
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
5486 Harbor Ave
Freeland, WA 98249-3002
Related CCNs
501339

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

Other NPIs with the same Medicare PAC ID 12

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

National Provider Directory

National Provider Directory
Tax ID family
Whidbey Island Pub Hospital38 organizations share this tax ID, including this one
Part of
Whidbey Island Pub Hospital

Other organizations with this tax ID 37

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

View all 37

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
Whidbey Island Public Hospital District Organization, Coupeville, WA Other Apr 1, 1969 100%
Curtis Andrew Shumate Individual Corporate DirectorExecutive Director of Nursing Feb 1, 2022
W-2 Managing Employee Feb 22, 2010
Kirk P Gasper Individual Corporate OfficerCommissioner Dec 2, 2025
Corporate DirectorCommissioner Dec 2, 2025
Garth a Miller Individual Corporate OfficerChief Operations Officer Sep 23, 2021
Corporate DirectorChief Operations Officer Sep 23, 2021
W-2 Managing Employee Aug 1, 2018
James Dean Golder Individual Corporate DirectorCommissioner Jan 1, 2022
Mark Ethan Borden Individual Corporate OfficerCommissioner Jan 1, 2026
Corporate DirectorCommissioner Jan 1, 2026
Marion Louise Jouas Individual Corporate DirectorCommissioner Dec 14, 2023
Jamie Canby Individual Corporate OfficerCommissioner Jan 1, 2026
Corporate DirectorCommissioner Jan 1, 2026
Kirsten M Andrews Individual Corporate DirectorMedical Director Jan 1, 2026
Paul Rogers Individual Corporate OfficerCfo Sep 16, 2022
Corporate DirectorCfo Sep 16, 2022
Nathan Staggs Individual Corporate OfficerCeo Mar 23, 2023
Corporate DirectorCeo Mar 23, 2023

Owners & managing parties with NPI records 13

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

View all 13

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
Whidbeyhealth Medical CenterCoupeville, WA, CCN 501339 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Whidbeyhealth Medical CenterCoupeville, WA, CCN 50Z339 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 1966
Whidbeyhealth Hospice CareCoupeville, WA, CCN 501542 Hospice 5% Or Greater Direct Ownership Interest (100%) Jan 30, 2013
Whidbeyhealth Primary Care - Goldie St.Oak Harbor, WA, CCN 503996 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 1, 1962
Jan 1, 1962
Whidbeyhealth Primary Care - ClintonClinton, WA, CCN 508506 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 1, 1962
Jan 1, 1962
Whidbeyhealth Primary Care - CabotOak Harbor, WA, CCN 508584 Rural health clinic Other Apr 1, 2011
Whidbeyhealth Primary Care - CoupevilleCoupeville, WA, CCN 508583 Rural health clinic Other (100%) Apr 1, 1969

Owned or controlled facilities with NPI records 12

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

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1509408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689811200000",
    "number": "1164934188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 462",
            "city": "FREELAND",
            "state": "WA",
            "postal_code": "982490462",
            "telephone_number": "360-331-5060",
            "fax_number": "360-331-2104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5486 HARBOR AVE",
            "city": "FREELAND",
            "state": "WA",
            "postal_code": "982493002",
            "telephone_number": "360-331-5060",
            "fax_number": "360-331-2104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT",
        "enumeration_date": "2017-10-31",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-20",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "GARTH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "360-678-7656"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WhidbeyHealth Primary Care - Freeland",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Freeland, WA

Sources for this page

Verify at the official NPI Registry.