NPIMap

Organization Active NPI

Ferry County Public Hospital District No 1

Doing business as Republic Medical Clinic

  • Rural Health Clinic/Center
  • Republic, WA
National Provider Identifier
1184776916
Registry record updated Jul 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FERRY COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Doing business as
Republic Medical Clinic
Practice address
10 Ros Circle
Republic, WA 99166-9701
Phone
(509) 775-3153
Fax
(509) 775-8929
NPI assigned
Jan 18, 2007
Last updated
Jul 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2025

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

Authorized official

Name
Mr. Brian Lady
Title
Ceo
Phone
(509) 775-3333

Specialties & licenses 1

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

Addresses

Primary practice location

10 Ros Circle
Republic, WA 99166-9701

Mailing address

36 Klondike Rd
Republic, WA 99166-9701
Phone (509) 775-3153

Other names 1

  • Republic Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040309000167 WA Part B Supplier - Clinic/Group Practice 0446148761 Receives reassigned benefits from 32 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Republic, WA
O20070920000639 WA Part A Provider - Rural Health Clinic 0446148761 Practice locations: Republic, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184776916. Details of each certification follow.

Rural health clinic certification: CCN 508522

Legal name
FERRY COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Doing business as
REPUBLIC MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 3, 2002
Last certification
Jun 9, 2015
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
10 Ros Cir
Republic, WA 99166-5002
Related CCNs
501322

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D1003649Republic Medical Clinic10 Ros Circle, Republic, WA 99166Provider-performed microscopyApr 4, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Nancy Giddings Individual Operational/Managerial ControlBoard Member Sep 3, 2014
Ferry County Public Hospital District No 1 Organization, Republic, WA Operational/Managerial Control Jan 25, 2007
Aaron C Edwards Individual W-2 Managing EmployeeCeo Apr 1, 2017
Dianne Lundgren Individual Operational/Managerial ControlBoard Member Jun 23, 2011
Julia Rae Santana Individual W-2 Managing Employee Oct 7, 2020
Ronald Brant Truman Individual W-2 Managing EmployeeCoo/Cfo Jan 1, 2018
Jody L Jannot Individual Operational/Managerial ControlBoard Member Sep 24, 2019
Sarah Krausse Individual Operational/Managerial ControlBoard Member Jan 24, 2017
Ronald Bacon Individual Operational/Managerial ControlBoard Member Nov 20, 2008

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Ferry County Memorial HospitalRepublic, WA, CCN 501322 Hospital Operational/Managerial Control Nov 20, 2007
Ferry County Memorial HospitalRepublic, WA, CCN 50Z322 Hospital Operational/Managerial Control Nov 20, 2007
Curlew Medical ClinicCurlew, WA, CCN 508533 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1989

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753056000000",
    "number": "1184776916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 KLONDIKE RD",
            "city": "REPUBLIC",
            "state": "WA",
            "postal_code": "991669701",
            "telephone_number": "509-775-3153",
            "fax_number": "509-775-8929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 ROS CIRCLE",
            "city": "REPUBLIC",
            "state": "WA",
            "postal_code": "991669701",
            "telephone_number": "509-775-3153",
            "fax_number": "509-775-8929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FERRY COUNTY PUBLIC HOSPITAL DISTRICT NO 1",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2025-07-21",
        "certification_date": "2025-07-21",
        "status": "A",
        "authorized_official_last_name": "LADY",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-775-3333",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Republic Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Republic, WA

Sources for this page

Verify at the official NPI Registry.