NPIMap

Organization Active NPI

Public Hospital District No 1 of Mason County

Doing business as Mason General Hospital Olympic Physicians

  • Rural Health Clinic/Center
  • Shelton, WA
National Provider Identifier
1306274667
Registry record updated Dec 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PUBLIC HOSPITAL DISTRICT NO 1 OF MASON COUNTY
Doing business as
Mason General Hospital Olympic Physicians
Practice address
221 Professional Way
Shelton, WA 98584-4404
Phone
(360) 426-2500
NPI assigned
Oct 24, 2013
Last updated
Dec 10, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2014

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

Authorized official

Name
Mr. Eric Moll
Title
Chief Executive Officer
Phone
(360) 427-9554

Specialties & licenses 1

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

Addresses

Primary practice location

221 Professional Way
Shelton, WA 98584-4404

Mailing address

221 Professional Way
Shelton, WA 98584-4404
Phone (360) 426-2500

Other names 1

  • Mason General Hospital Olympic Physicians Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131219001469 WA Part A Provider - Rural Health Clinic 0345139275 Practice locations: Shelton, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306274667. Details of each certification follow.

Rural health clinic certification: CCN 508565

Legal name
PUBLIC HOSPITAL DISTRICT NO 1 OF MASON COUNTY
Doing business as
MASON GENERAL HOSPITAL OLYMPIC PHYSICIANS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 1, 2013
Last certification
Apr 26, 2016
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Aug 19, 2003 in WA
Enrollment address
221 Professional Way
Shelton, WA 98584-4404
Related CCNs
501336

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

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Public Hosp Dist 1 Maso18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Public Hospital District No 1 of Mason County Organization, Shelton, WA Non-profit 5% Or Greater Direct Ownership Interest Dec 1, 2013 100%
Eric C Moll Individual Corporate OfficerCeo Apr 1, 2013
W-2 Managing Employee Feb 6, 2019
Stephen Leslie Individual W-2 Managing Employee Dec 1, 2022
Gayle Weston Individual Corporate Director Jan 1, 2023
Darrin Moody Individual Corporate Director Jan 1, 2023

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Mason Health-Mason ClinicShelton, WA, CCN 508549 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 22, 2008
Mason Health-Oakland Bay Primary CareShelton, WA, CCN 508527 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 19, 2010
Apr 19, 2010
Mason Health-Evergreen ClinicShelton, WA, CCN 508551 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Apr 23, 2009
Apr 23, 2009
Mason General Hospital Olympic PhysiciansShelton, WA, CCN 508564 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2013
Mason Health Hoodsport Primary CareHoodsport, WA, CCN 508566 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2014

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 5

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

NPI Registry JSON

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

{
    "created_epoch": "1382572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418169600000",
    "number": "1306274667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 PROFESSIONAL WAY",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985844404",
            "telephone_number": "360-426-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 PROFESSIONAL WAY",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985844404",
            "telephone_number": "360-426-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HOSPITAL DISTRICT NO 1 OF MASON COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-24",
        "last_updated": "2014-12-10",
        "status": "A",
        "authorized_official_last_name": "MOLL",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "360-427-9554",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mason General Hospital Olympic Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shelton, WA

Sources for this page

Verify at the official NPI Registry.