NPIMap

Organization Active NPI

Community Health of Central Washington

Doing business as Community Health of Central Washington-Ellensburg

  • Federally Qualified Health Center (FQHC)
  • Ellensburg, WA
National Provider Identifier
1205046141
Registry record updated Jul 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH OF CENTRAL WASHINGTON
Doing business as
Community Health of Central Washington-Ellensburg
Practice address
521 E Mountain View Ave
Ellensburg, WA 98926-3865
Phone
(509) 962-1414
Fax
(509) 962-1408
NPI assigned
May 22, 2007
Last updated
Jul 29, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2020

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

Authorized official

Name
Angela Gonzalez
Title
Ceo
Phone
(509) 494-6700

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

521 E Mountain View Ave
Ellensburg, WA 98926-3865

Mailing address

501 S 5TH Ave
Yakima, WA 98902-3550
Phone (509) 494-6700

Other identifiers 2

IdentifierTypeStateIssuer
31820OtherWALABOR AND INDUSTRIES
7118276MedicaidWA

Other names 1

  • Community Health of Central Washington-Ellensburg Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071114000492 WA Part A Provider - Federally Qualified Health Center (FQHC) 4183536931 1 other NPI on this enrollment
Practice locations: Ellensburg, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205046141. Details of each certification follow.

Federally qualified health center certification: CCN 501914

Legal name
COMMUNITY HEALTH OF CENTRAL WASHINGTON
Doing business as
COMMUNITY HEALTH OF CENTRAL WASHINGTON ELLENSBURG
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 9, 2008
Last certification
Jun 9, 2008
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1992 in WA
Enrollment address
521 East Mountainview Avenue
Ellensburg, WA 98926-3865

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 1

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

National Provider Directory

National Provider Directory
Tax ID family
Community Health of Central Washington14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

402 S 12th Ave
Bsmt
Yakima, WA 98902

402 S 12th Ave
Ste A
Yakima, WA 98902

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Earl Curtis Weatherman Individual Corporate Director Aug 1, 2007
James Michael Boutillier Individual Corporate Director Aug 1, 2007
Lisa Martin Individual W-2 Managing Employee Aug 1, 2007
Elizabeth Herres Miller Individual Corporate Director Aug 1, 2007
Paul Kaschmitter Individual Corporate Director Aug 1, 2007
Angela Gonzalez Individual 5% Or Greater Indirect Ownership InterestCeo Aug 19, 2019 100%
Corporate OfficerCeo Aug 19, 2019 100%
W-2 Managing EmployeeCeo Aug 19, 2019 100%
Desiree Ashbrooks Individual Corporate OfficerCfo Sep 1, 2021
Corporate DirectorCfo Sep 1, 2021
W-2 Managing EmployeeCfo Apr 24, 2008

Practitioners & affiliated clinicians

Practitioners 11

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": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595980800000",
    "number": "1205046141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S 5TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023550",
            "telephone_number": "509-494-6700",
            "fax_number": "509-573-6275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 E MOUNTAIN VIEW AVE",
            "city": "ELLENSBURG",
            "state": "WA",
            "postal_code": "989263865",
            "telephone_number": "509-962-1414",
            "fax_number": "509-962-1408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH OF CENTRAL WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-494-6700"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "31820",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7118276",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Health of Central Washington-Ellensburg",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Health of Central Washington-Ellensburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ellensburg, WA

Sources for this page

Verify at the official NPI Registry.