NPIMap

Organization Active NPI

Kittitas County Public Hospital Dist 1

Doing business as KVH Family Medicine - Cle Elum

  • Rural Health Clinic/Center
  • Cle Elum, WA
National Provider Identifier
1194747774
Registry record updated Oct 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Doing business as
KVH Family Medicine - Cle Elum
Practice address
201 Alpha Way
Cle Elum, WA 98922-1045
Phone
(509) 674-5331
Fax
(509) 674-5034
NPI assigned
Jul 24, 2006
Last updated
Oct 13, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
KITTITAS COUNTY PUBLIC HOSPITAL DIST 1As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 13, 2017

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

Authorized official

Name
Mrs. Jean Roberson
Title
Director Cbo
Phone
(509) 933-8771

Specialties & licenses 1

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

Addresses

Primary practice location

201 Alpha Way
Cle Elum, WA 98922-1045

Mailing address

P.O. Box 799
Ellensburg, WA 98926
Phone (509) 962-5060

Other names 1

  • KVH Family Medicine - Cle Elum Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040213000046 WA Part B Supplier - Clinic/Group Practice 0547179608 Receives reassigned benefits from 176 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ellensburg, WA; Cle Elum, WA
O20050831000802 WA Part A Provider - Rural Health Clinic 0547179608 Practice locations: Cle Elum, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194747774. Details of each certification follow.

Rural health clinic certification: CCN 508541

Legal name
KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Doing business as
KITTITAS VALLEY HEALTHCARE FAMILY MEDICINE CLE ELUM
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 28, 2002
Last certification
Apr 1, 2015
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jul 1, 2005 in WA
Enrollment address
201 Alpha Way
Cle Elum, WA 98922-1045
Related CCNs
501333

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 8

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
50D0638523KVH Family Medicine - Cle Elum201 Alpha Way, Cle Elum, WA 98922AccreditationApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Kittitas Valley Hosp16 organizations share this tax ID, including this one
Part of
Kittitas Valley Hosp

Other organizations with this tax ID 15

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

View all 15

Locations

201 Alpha Way
Cle Elum, WA 98922
Phone (509) 674-5331

Interoperability endpoints

  • Direct secure messaging: aoconnell@kittitasvalleyhealthcare.cernerdirect.com
  • Direct secure messaging: athomas1@kittitasvalleyhealthcare.cernerdirect.com
  • Direct secure messaging: cnewman@kittitasvalleyhealthcare.cernerdirect.com
  • Direct secure messaging: ewise@kittitasvalleyhealthcare.cernerdirect.com
  • Direct secure messaging: nwood@kittitasvalleyhealthcare.cernerdirect.com
  • Direct secure messaging: rmerkel@kittitasvalleyhealthcare.cernerdirect.com
  • Direct secure messaging: sheniges@kittitasvalleyhealthcare.cernerdirect.com

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
Lisa Gott Individual W-2 Managing EmployeeDirector Revenue Cycle Operations Jan 1, 2024
Kittitas County Public Hospital Dist 1 Organization, Cle Elum, WA Operational/Managerial Control Jul 1, 2005 100%
Rhonda Holden Individual Corporate DirectorChief Nursing Officer Dec 1, 2009
Jason Adler Individual Corporate OfficerCeo Dec 15, 2024
W-2 Managing EmployeeAd; Dec 15, 2024

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Kittitas Valley HealthcareEllensburg, WA, CCN 501333 Hospital Operational/Managerial Control (100%) Jan 1, 1966
Kittitas Valley HealthcareEllensburg, WA, CCN 50Z333 Hospital Operational/Managerial Control (100%) Jan 1, 2004
Kittitas Valley Healthcare Home HealthEllensburg, WA, CCN 507097 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 1964
Jan 1, 1964
Kittitas Valley Comm Hospital HospiceEllensburg, WA, CCN 501529 Hospice 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jul 25, 2008
Oct 3, 2011
Kittitas Valley Healthcare Internal MedicineEllensburg, WA, CCN 508545 Rural health clinic Operational/Managerial Control (100%) Jul 26, 2007
Medical Arts Center ClinicEllensburg, WA, CCN 508553 Rural health clinic Operational/Managerial Control (100%) Nov 1, 1966

Owned or controlled facilities with NPI records 6

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

Facilities with the same owner 6

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": "1153699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507852800000",
    "number": "1194747774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 799",
            "city": "ELLENSBURG",
            "state": "WA",
            "postal_code": "98926",
            "telephone_number": "509-962-5060",
            "fax_number": "509-674-5034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 ALPHA WAY",
            "city": "CLE ELUM",
            "state": "WA",
            "postal_code": "989221045",
            "telephone_number": "509-674-5331",
            "fax_number": "509-674-5034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KITTITAS COUNTY PUBLIC HOSPITAL DIST 1",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KITTITAS COUNTY PUBLIC HOSPITAL DIST 1",
        "enumeration_date": "2006-07-24",
        "last_updated": "2017-10-13",
        "status": "A",
        "authorized_official_last_name": "ROBERSON",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "DIRECTOR CBO",
        "authorized_official_telephone_number": "509-933-8771",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KVH Family Medicine - Cle Elum",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cle Elum, WA

Sources for this page

Verify at the official NPI Registry.