NPIMap

Organization Active NPI

New Health Programs Association

Doing business as NEW Health Loon Lake Medical

  • Federally Qualified Health Center (FQHC)
  • Loon Lake, WA
National Provider Identifier
1295799195
Registry record updated Jul 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
J600317870 Issued in WA
Legal business name
NEW HEALTH PROGRAMS ASSOCIATION
Doing business as
NEW Health Loon Lake Medical
Practice address
3994 Colville Rd
Loon Lake, WA 99148-9789
Phone
(509) 233-8412
Fax
(509) 233-2864
NPI assigned
Apr 17, 2006
Last updated
Jul 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2023

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

Authorized official

Name
Donna Poe
Title
Credentialing Specialist
Phone
(509) 935-6001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X J600317870 WA Primary

Addresses

Primary practice location

3994 Colville Rd
Loon Lake, WA 99148-9789

Mailing address

PO Box 808
Chewelah, WA 99109-0808
Phone (509) 935-6001

Other identifiers 3

IdentifierTypeStateIssuer
80300OtherWALABOR AND INDUSTRIES ID
7034077MedicaidWA
7034440MedicaidWA

Other names 1

  • NEW Health Loon Lake Medical Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040119000412 WA Part B Supplier - Clinic/Group Practice 1951202373 Receives reassigned benefits from 30 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Orient, WA; Springdale, WA; Northport, WA; Nine Mile Falls, WA; Newport, WA; Loon Lake, WA; Ione, WA; Colville, WA…
O20120315000490 WA Part A Provider - Federally Qualified Health Center (FQHC) 1951202373 Practice locations: Loon Lake, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295799195. Details of each certification follow.

Federally qualified health center certification: CCN 501810

Legal name
NEW HEALTH PROGRAMS ASSOCIATION
Doing business as
NEW HEALTH LOON LAKE MEDICAL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 20, 1978 in WA
Enrollment address
3994 Colville Rd
Loon Lake, WA 99148-9789
Related CCNs
507044

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

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Alison McGrane Individual Corporate OfficerChairperson Dec 1, 2017
Carmen Ann Deal Individual Corporate OfficerVice Chairperson Nov 14, 2013
Dale Storer Individual Corporate DirectorDirector May 12, 2016
Desiree L Sweeney Individual Corporate OfficerChief Executive Officer Oct 1, 2012
W-2 Managing Employee Oct 1, 2012
Operational/Managerial ControlChief Executive Officer Oct 1, 2012
Tracy Aynes Individual Corporate DirectorTreasurer Aug 15, 2019
Ellen Ballance Individual Corporate DirectorSecretary Jun 13, 2019

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1145232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689638400000",
    "number": "1295799195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 808",
            "city": "CHEWELAH",
            "state": "WA",
            "postal_code": "991090808",
            "telephone_number": "509-935-6001",
            "fax_number": "509-935-4196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3994 COLVILLE RD",
            "city": "LOON LAKE",
            "state": "WA",
            "postal_code": "991489789",
            "telephone_number": "509-233-8412",
            "fax_number": "509-233-2864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW HEALTH PROGRAMS ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-17",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A",
        "authorized_official_last_name": "POE",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "509-935-6001"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WA",
            "license": "J600317870",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES ID",
            "identifier": "80300",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7034077",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7034440",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NEW Health Loon Lake Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Loon Lake, WA

Sources for this page

Verify at the official NPI Registry.