NPIMap

Organization Active NPI

Columbia County Hospital District

Doing business as Waitsburg Clinic

  • Rural Health Clinic/Center
  • Waitsburg, WA
National Provider Identifier
1215018346
Registry record updated Apr 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COLUMBIA COUNTY HOSPITAL DISTRICT
Doing business as
Waitsburg Clinic
Practice address
235 Main Street
Waitsburg, WA 99361
Phone
(509) 337-6311
Fax
(509) 337-6011
NPI assigned
Oct 17, 2006
Last updated
Apr 26, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
COLUMBIA COUNTY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 26, 2022

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

Authorized official

Name
Mr. Matt Minor
Title
Cfo
Phone
(509) 382-2531

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU
Rural Health Clinic/Center 261QR1300X H141 WA
Rural Health Clinic/Center 261QR1300X WA Primary

Addresses

Primary practice location

235 Main Street
Waitsburg, WA 99361

Mailing address

1012 South Third Street
Dayton, WA 99328
Phone (509) 382-2531

Other identifiers 1

IdentifierTypeStateIssuer
1043278MedicaidWA

Other names 1

  • Waitsburg Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cchd-wa@844.direct.myezyaccess.com

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040309000515 WA Part B Supplier - Clinic/Group Practice 5597653758 Receives reassigned benefits from 170 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: College Place, WA; Dayton, WA; Waitsburg, WA
O20101007000177 WA Part A Provider - Rural Health Clinic 5597653758 Practice locations: Waitsburg, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215018346. Details of each certification follow.

Rural health clinic certification: CCN 503978

Legal name
COLUMBIA COUNTY HOSPITAL DISTRICT
Doing business as
WAITSBURG CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 27, 1993
Last certification
Mar 19, 2019
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
Oct 3, 1960 in WA
Enrollment address
235 Main Street
Waitsburg, WA 99361
Related CCNs
501302

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Dayton General Hospital6 organizations share this tax ID, including this one
Part of
Dayton General Hospital

Other organizations with this tax ID 5

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

Locations

295 S College Ave
#1
College Place, WA 99324
Phone (509) 382-2531

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
Erin Trump Individual Corporate Officer Sep 1, 2017
Corporate Director Sep 1, 2017
W-2 Managing Employee Sep 1, 2017
Operational/Managerial Control Sep 1, 2017
Columbia County Hospital District Organization, Dayton, WA 5% Or Greater Direct Ownership Interest Sep 27, 1993 100%
Shane McGuire Individual Corporate OfficerCeo Aug 1, 2013
Corporate DirectorCeo Aug 1, 2013
W-2 Managing EmployeeCeo Aug 1, 2013
Operational/Managerial ControlCeo Aug 1, 2013
Matt Minor Individual Corporate OfficerCfo Apr 9, 2019
Corporate DirectorCfo Apr 9, 2019
W-2 Managing EmployeeCfo Apr 9, 2019
Operational/Managerial ControlCfo Apr 9, 2019

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Dayton General HospitalDayton, WA, CCN 501302 Hospital 5% Or Greater Direct Ownership Interest (100%) Dec 5, 2007
Medicare Swing Bed UnitDayton, WA, CCN 50Z302 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2000
Columbia County Hospital DistrictDayton, WA, CCN 505437 Skilled nursing facility 5% Or Greater Direct Ownership Interest May 23, 1990
Columbia Family ClinicDayton, WA, CCN 503977 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 29, 1993

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 31

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 31

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650931200000",
    "number": "1215018346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 SOUTH THIRD STREET",
            "city": "DAYTON",
            "state": "WA",
            "postal_code": "99328",
            "telephone_number": "509-382-2531",
            "fax_number": "509-382-3205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 MAIN STREET",
            "city": "WAITSBURG",
            "state": "WA",
            "postal_code": "99361",
            "telephone_number": "509-337-6311",
            "fax_number": "509-337-6011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLUMBIA COUNTY HOSPITAL DISTRICT",
        "enumeration_date": "2006-10-17",
        "last_updated": "2022-04-26",
        "certification_date": "2022-04-26",
        "status": "A",
        "authorized_official_last_name": "MINOR",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "509-382-2531",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WA",
            "license": "H141",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043278",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cchd-wa@844.direct.myezyaccess.com",
            "affiliation": "N",
            "endpointDescription": "Grapevine-Qvera",
            "address_1": "235 Main Street",
            "city": "Waitsburg",
            "state": "WA",
            "country_code": "US",
            "postal_code": "99361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Waitsburg Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Waitsburg Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waitsburg, WA

Sources for this page

Verify at the official NPI Registry.