NPIMap

Organization Active NPI

Public Hospital District 3 of Pacific County

Doing business as Ocean Beach Hospital

  • Critical Access Hospital
  • Ilwaco, WA
National Provider Identifier
1295771376
Registry record updated Mar 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY
Doing business as
Ocean Beach Hospital
Practice address
174 1St Avenue North
Ilwaco, WA 98624-0258
Phone
(360) 642-3181
Fax
(360) 642-6309
NPI assigned
Jun 20, 2006
Last updated
Mar 12, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2019

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

Authorized official

Name
Larry Cohen
Title
Ceo
Phone
(360) 642-3181

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital Clinic/Center 261QC0050X H-079 WA
Critical Access Hospital 282NC0060X Primary

Addresses

Primary practice location

174 1St Avenue North
Ilwaco, WA 98624-0258

Mailing address

PO Box H
Ilwaco, WA 98624-0258
Phone (360) 642-3181

Other identifiers 3

IdentifierTypeStateIssuer
H-079OtherWASTATE OF WA DOH LICENSE
MT0804OtherWADOH MED. TEST LICENSE
3627502MedicaidWA

Other names 1

  • Ocean Beach Hospital Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040219000157 WA Part B Supplier - Clinic/Group Practice 7214822105 Receives reassigned benefits from 33 practitioners
5 other NPIs on this enrollment
Practice locations: Ilwaco, WA; Long Beach, WA; Naselle, WA; Ocean Park, WA
O20060504000559 WA Part A Provider - Critical Access Hospital 7214822105 Receives reassigned benefits from 22 practitioners
Practice locations: Ilwaco, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295771376. Details of each certification follow.

Hospital certification: CCN 501314

Legal name
PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY
Doing business as
OCEAN BEACH HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Feb 1, 2002
Last certification
Nov 5, 2021
Beds
15
Ownership / control type
Hospital district or authority
Organization structure
CorporationNon-profit
Enrollment address
174 1St Ave N
Ilwaco, WA 98624-9137
Other Hospital Practice Location

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.

Care Compare: Hospital

Medicare Care Compare
Listed as
Ocean Beach HospitalCCN 501314 · All quality measures
Overall star rating
2 of 5
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Nancy Gorshe Individual Corporate DirectorBoard Member Jan 1, 2012
Elise Chayet Individual Corporate DirectorBoard Member May 1, 2024
Sandra Stonebreaker Individual Corporate DirectorBoard of Commissioner Jan 1, 2018
Madeline Moore Individual Corporate DirectorBoard Member Jan 1, 2016
Ariel Smith Individual Corporate DirectorBoard Member Jan 1, 2016
Public Hospital District 3 of Pacific County Organization, Ilwaco, WA Non-profit Operational/Managerial Control Nov 17, 2007
Merry-Ann J Keane Individual Corporate OfficerCeo Jan 1, 2024
W-2 Managing EmployeeCeo Jan 1, 2024
Eric Volk Individual Corporate OfficerChief Financial Officer May 1, 2024

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
Ocean Beach HospitalIlwaco, WA, CCN 50Z314 Hospital Operational/Managerial Control Feb 15, 2008
Ocean Beach Medical ClinicIlwaco, WA, CCN 503988 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 14, 1995
Naselle ClinicNaselle, WA, CCN 503984 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1994
Ocean Beach Medical Group - Ocean ParkOcean Park, WA, CCN 508578 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2018

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 42

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 42

Affiliated clinicians 127

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 127

NPI Registry JSON

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552348800000",
    "number": "1295771376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX H",
            "city": "ILWACO",
            "state": "WA",
            "postal_code": "986240258",
            "telephone_number": "360-642-3181",
            "fax_number": "360-642-6309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "174 1ST AVENUE NORTH",
            "city": "ILWACO",
            "state": "WA",
            "postal_code": "986240258",
            "telephone_number": "360-642-3181",
            "fax_number": "360-642-6309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2019-03-12",
        "status": "A",
        "authorized_official_last_name": "COHEN",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "360-642-3181"
    },
    "taxonomies": [
        {
            "code": "261QC0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Critical Access Hospital",
            "state": "WA",
            "license": "H-079",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF WA DOH LICENSE",
            "identifier": "H-079",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOH MED. TEST LICENSE",
            "identifier": "MT0804",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3627502",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ocean Beach Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ocean Beach Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ilwaco, WA

Sources for this page

Verify at the official NPI Registry.