Providence Health & Services - Washington

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

PROVIDENCE HEALTH & SERVICES - WASHINGTON

Practice address

18313 Paulson St SW
Suite a
Rochester, WA 98579-9262

Phone

(360) 827-8400

Fax

(360) 273-7301

NPI assigned

Sep 13, 2006

Last updated

May 13, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Donald Wayne Anderson Jr.

Title

Asst Corp Sec for Enrollments

Phone

(425) 358-9786

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205931508. Details of each certification follow.

• CCN 503839 Rural health clinic · Active · Details

Rural health clinic certification: CCN 503839

Legal name

PROVIDENCE HEALTH & SERVICES - WASHINGTON

Doing business as

PMG SW WA ROCHESTER FAM MED

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Apr 10, 1996

Last certification

Mar 8, 2017

Ownership / control type

2B

Organization structure

CorporationNon-profit

Incorporated

Jan 28, 1859 in WA

Enrollment address

18313 Paulson St. SW
Suite a
Rochester, WA 98579-9262

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Providence Health & Services Washington

  dba Providence Centralia Hospital

  • Radiation Oncology Clinic/Center
  • Aberdeen, WA
  • NPI 1457721250

  Member Of

  NPD member

Locations

All disclosed owners & managing parties 23

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

Owners & managing parties with NPI records 1

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

• Darryl A Elmouchi, MD

  • Clinical Cardiac Electrophysiology Physician
  • Grand Rapids, MI
  • NPI 1548240732

  Corporate Officer

  CMS ownership

Facilities with the same owner 141

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

• CP King County Wa HH, LLC

  dba Providence at Home with Compassus Home Health, King

  • Home Health Agency
  • Tukwila, WA
  • NPI 1972325983

  Providence Health & Services, Providence Health & Services - Washington, Providence St. Joseph Health

  CMS ownership
• CP Seattle Wa Hospice, LLC

  dba Providence at Home with Compassus Hospice Care, Puget Sound

  • Community Based Hospice Care Agency
  • Tukwila, WA
  • NPI 1174345193

  Providence Health & Services, Providence Health & Services - Washington, Providence St. Joseph Health

  CMS ownership
• CP Snohomish County Wa, LLC

  dba Providence at Home with Compassus Home Health, Snohomish County

  • Community Based Hospice Care Agency
  • Everett, WA
  • NPI 1184446221

  Providence Health & Services, Providence Health & Services - Washington, Providence St. Joseph Health

  CMS ownership
• CP Snohomish County Wa, LLC

  dba Providence at Home with Compassus Hospice Care, Snohomish County

  • Home Health Agency
  • Everett, WA
  • NPI 1720800857

  Providence Health & Services, Providence Health & Services - Washington, Providence St. Joseph Health

  CMS ownership
• CP Sound Wa, LLC

  dba Providence at Home with Compassus Hospice Care, Puget Sound South

  • Community Based Hospice Care Agency
  • Lacey, WA
  • NPI 1659193795

  Providence Health & Services, Providence Health & Services - Washington, Providence St. Joseph Health

  CMS ownership
• CP Sound Wa, LLC

  dba Providence at Home with Compassus Home Health, Puget Sound South

  • Home Health Agency
  • Lacey, WA
  • NPI 1669294708

  Providence Health & Services, Providence Health & Services - Washington, Providence St. Joseph Health

  CMS ownership
• CP Spokane Wa HH, LLC

  dba Providence at Home with Compassus Home Health, INWA

  • Home Health Agency
  • Spokane Valley, WA
  • NPI 1033931043

  Providence Health & Services, Providence Health & Services - Washington, Providence St. Joseph Health

  CMS ownership
• CP St. Mary Wa HH, LLC

  dba Providence at Home with Compassus Home Health, Walla Walla

  • Home Health Agency
  • Walla Walla, WA
  • NPI 1730901745

  Providence Health & Services, Providence Health & Services - Washington, Providence St. Joseph Health

  CMS ownership
• Kadlec Regional Medical Center

  • General Acute Care Hospital
  • Richland, WA
  • NPI 1972507580

  Providence Health & Services - Washington

  CMS ownership
• Northwest Washington Rehabilitation Hospital LLC

  dba Providence Swedish Rehabilitation Hospital

  • Rehabilitation Hospital
  • Lynnwood, WA
  • NPI 1306628821

  Providence Health & Services - Washington

  CMS ownership
• Providence Health & Services - Wa

  dba Prov Scred Hrt Med Ctr & Chlds Hos

  • General Acute Care Hospital
  • Spokane, WA
  • NPI 1144471715

  Providence Health & Services, Providence Health & Services - Washington, Providence St. Joseph Health

  CMS ownership
• Providence Health & Services - Wa

  dba Providence St Joseph Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Chewelah, WA
  • NPI 1447402839

  Providence Health & Services, Providence Health & Services - Washington, Providence St. Joseph Health

  CMS ownership

Practitioners 25

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.

• Jordan M Abel, MD

  • Family Medicine Physician
  • Rochester, WA
  • NPI 1821438029
  Medicare reassignment Care Compare group NPD
• Susan Renae Carlton, ARNP

  • Family Nurse Practitioner
  • Rochester, WA
  • NPI 1710684105
  Medicare reassignment Care Compare group NPD
• Calvin Clarke

  • Family Nurse Practitioner
  • Puyallup, WA
  • NPI 1851761027
  Medicare reassignment Care Compare group NPD
• Jami Larson, LICSW

  • Clinical Social Worker
  • Chehalis, WA
  • NPI 1215084280
  Medicare reassignment Care Compare group NPD
• Pooja M Patel, MD

  • Family Medicine Physician
  • Olympia, WA
  • NPI 1912434317
  Medicare reassignment Care Compare group NPD
• Katty Raisor, ARNP

  • Family Nurse Practitioner
  • Rochester, WA
  • NPI 1104695485
  Medicare reassignment Care Compare group NPD
• Andrew Paul Patel, M.D.

  • Family Medicine Physician
  • Fulton, MO
  • NPI 1235579756

  WA

  Medicare reassignment Care Compare group NPD
• Stephanie S Looi, MD

  • Family Medicine Physician
  • Centralia, WA
  • NPI 1649776063
  Medicare reassignment Care Compare group
• Michelle L Patton, LICSW

  • Clinical Social Worker
  • Centralia, WA
  • NPI 1699922328
  Medicare reassignment Care Compare group
• Morgane Marielle Atienza, ARNP

  • Family Nurse Practitioner
  • Kirkland, WA
  • NPI 1982100657
  Medicare reassignment NPD
• Jane M. Geraci, M.D., MPH

  • Internal Medicine Physician
  • Lacey, WA
  • NPI 1568560241
  Medicare reassignment NPD
• Kenneth Wayne Kooser, M.D.

  • Family Medicine Physician
  • Lacey, WA
  • NPI 1306920772
  Medicare reassignment NPD

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747094400000",
    "number": "1205931508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-4114",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104114",
            "telephone_number": "503-893-7120",
            "fax_number": "425-276-3215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18313 PAULSON ST SW",
            "address_2": "SUITE A",
            "city": "ROCHESTER",
            "state": "WA",
            "postal_code": "985799262",
            "telephone_number": "360-827-8400",
            "fax_number": "360-273-7301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASST CORP SEC FOR ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• N W Pediatric Center Inc P S
• Darren Michael Nealis, LICSW
• Courtney Jeanette Oliver, COTA/L, RBT/CBT
• Options Consulting, PLLC
• Brian D Ottesen, ARNP
• Providence Health & Services - Washington
• Quixote Consulting
• Katty Raisor, ARNP
• Gerardo A Ramirez Sr., MC8584
• Claudia J Randall, LMP

• Rural Health Clinic/Center in Rochester, WA
• Providers in Rochester, WA by specialty
• Rural Health Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.