NPIMap

Organization Active NPI

Jefferson County Public Hospital District No 2

Doing business as Jefferson Healthcare Walk in Clinic

  • Medical Physician Assistant
  • Port Townsend, WA
National Provider Identifier
1194032201
Registry record updated Dec 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
HAC.FS.00000085 Issued in WA
Legal business name
JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Doing business as
Jefferson Healthcare Walk in Clinic
Practice address
1274 7TH St Ste a
Port Townsend, WA 98368-2404
Phone
(360) 379-0477
NPI assigned
Sep 10, 2010
Last updated
Dec 9, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 9, 2010

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

Authorized official

Name
Ms. Kathy Lee Porter, CHAM
Title
Registration Coordinator
Phone
(360) 385-2200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X HAC.FS.00000085 WA Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X HAC.FS.00000085 WA

Addresses

Primary practice location

1274 7TH St Ste a
Port Townsend, WA 98368-2404

Mailing address

834 Sheridan St
Port Townsend, WA 98368-2443
Phone (360) 385-2200

Other names 1

  • Jefferson Healthcare Walk in Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031111000542 WA Part B Supplier - Clinic/Group Practice 4789593708 Receives reassigned benefits from 231 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Quilcene, WA; Port Townsend, WA; Port Ludlow, WA; Bellingham, WA

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Part of
G C Forbes K D Forbes

NPI Registry JSON

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

{
    "created_epoch": "1284076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291852800000",
    "number": "1194032201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "834 SHERIDAN ST",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983682443",
            "telephone_number": "360-385-2200",
            "fax_number": "360-379-2282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1274 7TH ST STE A",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983682404",
            "telephone_number": "360-379-0477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2",
        "enumeration_date": "2010-09-10",
        "last_updated": "2010-12-09",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "REGISTRATION COORDINATOR",
        "authorized_official_telephone_number": "360-385-2200",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CHAM"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "HAC.FS.00000085",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "HAC.FS.00000085",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Healthcare Walk in Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Townsend, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.