NPIMap

Organization Active NPI

Sea Mar Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Vancouver, WA
National Provider Identifier
1184047441
Registry record updated Feb 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SEA MAR COMMUNITY HEALTH CENTERS
Practice address
14508 NE 20TH Ave Ste 300
Vancouver, WA 98686-6418
Phone
(360) 892-0208
Fax
(360) 892-9081
NPI assigned
Jan 22, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2025

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

Authorized official

Name
Mary Bartolo
Title
Executive Vice President
Phone
(206) 763-5277

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

14508 NE 20TH Ave Ste 300
Vancouver, WA 98686-6418

Mailing address

PO Box 34703
Seattle, WA 98124-1703

Other identifiers 1

IdentifierTypeStateIssuer
2041411MedicaidWA

Other names 2

  • Sea-Mar Community Health Center Former legal business name
  • Sea Mar CHC Vancouver Salmon Creek - Women's Clinic Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040211001210 WA Part B Supplier - Clinic/Group Practice 7315831161 Receives reassigned benefits from 551 practitioners
41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mount Vernon, WA; Ocean Shores, WA; Olympia, WA; Puyallup, WA; Seattle, WA; Spanaway, WA; Everett, WA; Tacoma, WA…
O20140717002087 WA Part A Provider - Federally Qualified Health Center (FQHC) 7315831161 Practice locations: Vancouver, WA

Federally qualified health center certification: CCN 501970

Legal name
SEA MAR COMMUNITY HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 16, 2014
Last certification
Jul 16, 2014
Ownership / control type
Non-profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 14, 1977 in WA
Enrollment address
14508 NE 20TH Ave
Ste 300
Vancouver, WA 98686-6418

Other NPIs on the same Medicare enrollment 41

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

View all 41

National Provider Directory

National Provider Directory
Tax ID family
Sea Mar Marysville Medi278 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

11801 NE 65th St
Vancouver, WA 98662
Phone (360) 558-5790

14508 NE 20th Ave
Vancouver, WA 98686
Phone (360) 397-9211

14508 NE 20th Ave
Ste 300
Vancouver, WA 98686
Phone (360) 433-0022

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Juan Enrique Garza Individual Corporate Director Aug 6, 2024 9%
Daniela Diaz de la Vega Gonzales Individual Corporate DirectorPatient/Homeless Representative Jun 6, 2023 9%
Mary Bartolo Individual Corporate OfficerExecutive Vice President Jun 1, 1978
W-2 Managing EmployeeExecutive Vice President Apr 17, 1978
Agustin Delgado Individual Corporate Director Mar 13, 2013 9%
Kristina Kathleen Hoeschen Individual Corporate OfficerChief Compliance Officer May 1, 2017
Ricardo Gasca Individual Corporate Director Oct 1, 2016 9%
Gregory J Ma Individual Corporate Director Sep 1, 1982 9%
Bertha Michelle Danley Individual Corporate Director Nov 1, 2010 9%
Felipe Trinidad-Martinez Individual Corporate Director May 1, 2008 9%
Erasmo Gamboa Individual Corporate Director Apr 10, 2010 9%
Rogelio Riojas Individual Corporate OfficerCeo Jun 19, 1978
Silverio Vivanco-Sanchez Individual Corporate Director May 1, 2008 9%
Jesus R Sanchez Individual Corporate Director Feb 4, 2025 9%

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Sea Mar CHC-Vashon IslandVashon, WA, CCN 941082 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 19, 1978
Sea Mar Community Health CentersSpanaway, WA, CCN 941095 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 19, 1978

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1390348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740528000000",
    "number": "1184047441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34703",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14508 NE 20TH AVE STE 300",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986866418",
            "telephone_number": "360-892-0208",
            "fax_number": "360-892-9081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEA MAR COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-22",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-26",
        "status": "A",
        "authorized_official_last_name": "BARTOLO",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "206-763-5277"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2041411",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sea-Mar Community Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Sea Mar CHC Vancouver Salmon Creek - Women's Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.