NPIMap

Organization Active NPI

Peacehealth

Doing business as St. John Medical Center - Outpatient Therapy

  • Physical Therapist
  • Longview, WA
National Provider Identifier
1275501538
Registry record updated Jul 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PEACEHEALTH
Doing business as
St. John Medical Center - Outpatient Therapy
Practice address
852 Commerce Ave
Longview, WA 98632-2406
Phone
(360) 501-3750
Fax
(360) 501-3755
NPI assigned
Mar 10, 2006
Last updated
Jul 29, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2011

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

Authorized official

Name
Mr. Thomas Haywood
Title
Regional VP/Cfo
Phone
(360) 414-5797

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X NU
Physical Medicine & Rehabilitation Physician 208100000X NU
Occupational Therapy Assistant 224Z00000X NU
Physical Therapist 225100000X NU Primary
Physical Therapy Assistant 225200000X NU
Occupational Therapist 225X00000X NU

Addresses

Primary practice location

852 Commerce Ave
Longview, WA 98632-2406

Mailing address

PO Box 3002
Longview, WA 98632-0302
Phone (360) 501-3750

Other names 1

  • St. John Medical Center - Outpatient Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040209000272 WA Part B Supplier - Clinic/Group Practice 5890689293 Receives reassigned benefits from 327 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Woodland, WA; Longview, WA

Other NPIs on the same Medicare enrollment 2

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

  • Peacehealth

    dba St. John Medical Center

    • General Acute Care Hospital
    • Longview, WA
    • NPI 1073510277

    O20040209000272

    Same enrollment
  • Peacehealth

    dba St. John Medical Center - PeaceHealth Medical Group

    • Multi-Specialty Clinic/Center
    • Longview, WA
    • NPI 1720056187

    O20040209000272

    Same enrollment

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 136

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 136

NPI Registry JSON

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

{
    "created_epoch": "1141948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311897600000",
    "number": "1275501538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3002",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986320302",
            "telephone_number": "360-501-3750",
            "fax_number": "360-501-3755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "852 COMMERCE AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322406",
            "telephone_number": "360-501-3750",
            "fax_number": "360-501-3755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACEHEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-10",
        "last_updated": "2011-07-29",
        "status": "A",
        "authorized_official_last_name": "HAYWOOD",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "REGIONAL VP/CFO",
        "authorized_official_telephone_number": "360-414-5797",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. John Medical Center - Outpatient Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Longview, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.