NPIMap

Organization Active NPI

Public Hospital District No 4 King County Washington

Doing business as Snoqualmie Ridge Medical Clinic

  • Rural Health Clinic/Center
  • Snoqualmie, WA
National Provider Identifier
1194237131
Registry record updated Dec 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
H195 Issued in WA
Legal business name
PUBLIC HOSPITAL DISTRICT NO 4 KING COUNTY WASHINGTON
Doing business as
Snoqualmie Ridge Medical Clinic
Practice address
35020 SE Kinsey St
Snoqualmie, WA 98065-8992
Phone
(425) 396-7682
Fax
(425) 396-7694
NPI assigned
Oct 31, 2017
Last updated
Dec 16, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PUBLIC HOSPITAL DISTRICT NO 4 KING COUNTY WASHINGTONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 16, 2025

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

Authorized official

Name
Barbi Donovan
Title
MSS & Pe Manager
Phone
(425) 831-2321

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X H195 WA Primary

Addresses

Primary practice location

35020 SE Kinsey St
Snoqualmie, WA 98065-8992

Mailing address

35020 SE Kinsey St
Snoqualmie, WA 98065-8992
Phone (425) 831-2300

Other names 1

  • Snoqualmie Ridge Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180213003060 WA Part A Provider - Rural Health Clinic 6002700861 Practice locations: Snoqualmie, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194237131. Details of each certification follow.

Rural health clinic certification: CCN 508580

Legal name
PUBLIC HOSPITAL DISTRICT NO 4 KING COUNTY WASHINGTON
Doing business as
SNOQUALMIE RIDGE MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 9, 2018
Last certification
Oct 9, 2018
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
35020 SE Kinsey St
Snoqualmie, WA 98065-8992
Related CCNs
501338

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).

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
50D2148041Snoqualmie Ridge Medical Clinic35020 SE Kinsey St, Snoqualmie, WA 98065Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Public Hosp Dist No 4 King7 organizations share this tax ID, including this one
Part of
Public Hosp Dist No 4 King

Other organizations with this tax ID 6

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

35020 SE Kinsey St
Ste B
Snoqualmie, WA 98065
Phone (425) 831-3800

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Renee K Jensen Individual Corporate OfficerCeo Nov 30, 2020 5%
Public Hospital District No 4 King County Washington Organization, Snoqualmie, WA 5% Or Greater Direct Ownership Interest Jan 1, 2018 100%
James Patrick Ritter Individual Corporate OfficerCfo Dec 1, 2019 5%
Barbi Donovan Individual W-2 Managing EmployeeDirector, Medical Staff Services Jan 1, 2007

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
Snoqualmie Valley HospitalSnoqualmie, WA, CCN 501338 Hospital Other (100%) Dec 31, 2005
Snoqualmie Valley HospitalSnoqualmie, WA, CCN 50Z338 Hospital Other (100%) Jan 1, 1973
Snoqualmie Valley Hospital ClinicSnoqualmie, WA, CCN 508579 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2018

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 1

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

Practitioners & affiliated clinicians

Practitioners 10

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": "1765843200000",
    "number": "1194237131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35020 SE KINSEY ST",
            "city": "SNOQUALMIE",
            "state": "WA",
            "postal_code": "980658992",
            "telephone_number": "425-831-2300",
            "fax_number": "425-831-2361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35020 SE KINSEY ST",
            "city": "SNOQUALMIE",
            "state": "WA",
            "postal_code": "980658992",
            "telephone_number": "425-396-7682",
            "fax_number": "425-396-7694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HOSPITAL DISTRICT NO 4 KING COUNTY WASHINGTON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PUBLIC HOSPITAL DISTRICT NO 4 KING COUNTY WASHINGTON",
        "enumeration_date": "2017-10-31",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "status": "A",
        "authorized_official_last_name": "DONOVAN",
        "authorized_official_first_name": "BARBI",
        "authorized_official_title_or_position": "MSS & PE MANAGER",
        "authorized_official_telephone_number": "425-831-2321"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WA",
            "license": "H195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Snoqualmie Ridge Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Snoqualmie, WA

Sources for this page

Verify at the official NPI Registry.