Pacific County Hospital District 2
Organization Active NPI Critical Access Hospital · South Bend, WA
NPI 1295708683 · NPPES record last updated Jun 12, 2012
Key facts
- NPI
- 1295708683
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- Legal business name
- PACIFIC COUNTY HOSPITAL DISTRICT 2
- Practice address
- 800 Alder St
South Bend, WA 98586 - Phone
- (360) 875-5526
- Fax
- (360) 875-6167
- NPI assigned
- Feb 8, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Terry Stone
- Title
- Cfo
- Phone
- (360) 875-4508
Owners & managing parties with NPI records 1
Other NPIs with the same Medicare PAC ID 1
Related certifications (CCN) 1
Practitioners 253
-
Blake Ron Busey, D.O.
-
Sherry A Franks, PA-C
-
Steven Frederick Hill, D.O.
-
Marcus Eric Kuypers, M.D.
-
Robert Francis Oatfield, D.O.
-
Mary Lee Phillips, A.P.R.N., F.N.P.
-
Jeremy P Quinn, PA
-
John BN Shaw, MD
-
Melissa Smedley, NP
-
Fahad Younas, M.D.
-
Haroon Yousaf, MD
-
Augustine Ajuogu, MD
-
Annum A Bhullar, M.D.
-
Nicholas Patrick Nunez, M.D.
-
Brenda Pearl Smith, M.D., F.A.C.E.P.
-
Carol Wente Snider, AGACNP-BC
-
Luiz Souza-Filho, M.D.
-
Charles Robert Teames II, CRNA
Affiliated clinicians 83
-
Soo Ryun Ahn, MD
-
Natasha P Arora, MD
-
Jawaid Ahmad Behnawa, M.D
-
James E. Bell I, MD
-
Charles Best, M.D.
-
Keith R Birchard, MD
-
Mandie Michelle Brown, ARNP
-
Blake Ron Busey, D.O.
-
Katie Elise Clarkson, MSN, ARNP, BC
-
Holly Celeste Clements, ARNP
-
Megan McKenzie Colburn, ARNP
-
Aliakbar Rashid Dadla, M.D.
-
Shelly Joyce Dueber, D.O.
-
Pawel Michal Dutkiewicz, M.D.
-
Sherry A Franks, PA-C
-
Philip Gibbs, MD
-
Julio C. Gonzalez, M.D.
-
Lucas S Harvey, M.D.
-
Steven Frederick Hill, D.O.
-
Robert L Hovancsek, DPM
-
John R Kuczynski, M.D.
-
Marcus Eric Kuypers, M.D.
Medicare Care Compare: Hospital
- Listed as
- Willapa Harbor Hospital
- Type
- Critical Access Hospitals
- Ownership
- Government - Hospital District or Authority
- Medicare certification status
- Active
- Emergency services
- Yes
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 50D0637271 | Willapa Harbor Hospital Laboratory | Compliance | Apr 4, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in WA
Hospital certification: CCN 501303
- Legal name
- PACIFIC COUNTY HOSPITAL DISTRICT 2
- Doing business as
- WILLAPA HARBOR HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Apr 1, 2000
- Last certification
- Oct 18, 2023
- Beds
- 25 (15 certified)
- Ownership / control type
- Hospital district or authority
- Organization structure
- Other · Non-profit
- Incorporated
- Jun 1, 1954 in WA
- Enrollment address
- 800 Alder St
South Bend, WA 98586-4900
Hospital certification: CCN 50Z303
- Legal name
- PACIFIC COUNTY HOSPITAL DISTRICT 2
- Doing business as
- WILLAPA HARBOR HOSPITAL
- Organization structure
- Other · Non-profit
- Incorporated
- Jun 1, 1954 in WA
- Enrollment address
- 800 Alder St
South Bend, WA 98586-4900
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Kimberly Polanco |
Corporate Officer |
Apr 24, 2023 | |
| Matthew B Kempton |
Corporate Officer |
Dec 2, 2019 | 100% |
| W-2 Managing Employee |
Dec 2, 2019 | ||
| Corporate Officer |
Dec 1, 2019 | ||
| W-2 Managing Employee |
Dec 1, 2019 | ||
| Pacific County Hospital District 2 |
5% Or Greater Direct Ownership Interest | Jan 1, 1966 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040120000991 | WA | Part B Supplier - Clinic/Group Practice | 8224939301 |
Receives reassigned benefits from 105 practitioners Practice locations: South Bend, WA |
| O20070621000674 | WA | Part a Provider - Critical Access Hospital | 8224939301 |
Receives reassigned benefits from 141 practitioners Practice locations: South Bend, WA |
| O20080828000534 | WA | Part a Provider - Critical Access Hospital | 8224939301 | Practice locations: South Bend, WA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | Yes |
Addresses
Primary practice location
800 Alder St
South Bend, WA 98586
Mailing address
PO Box 438
800 Alder St
South Bend, WA 98586
Phone (360) 875-5526
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3300308 | Medicaid | WA |
Other names
- Willapa Harbor Hospital
Other providers in South Bend, WA
- Amber Lee Jacobs
- Sambasivarao Venkata Karanam
- Trudi K Kulp
- Myograsp Bodywork
- Amir Sean Nagavi
- Pacific County Hospital District 2
- Pacific County Hospital District 2
- Pacific County Public Hospital District # 2
- Stan W Pniewski
- Aliza Quinlan
All providers in South Bend, WA · Critical Access Hospital in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.