NPIMap

Public Hospital District No 1 of Mason County

Organization Active NPI Rural Health Clinic/Center · Shelton, WA

NPI 1306274667 · NPPES record last updated Dec 10, 2014

Key facts

NPI
1306274667
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
PUBLIC HOSPITAL DISTRICT NO 1 OF MASON COUNTY
Practice address
221 Professional Way
Shelton, WA 98584-4404
Phone
(360) 426-2500
NPI assigned
Oct 24, 2013
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 6

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

Owned or controlled facilities with NPI records 5

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

Other NPIs with the same Medicare PAC ID 6

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

Corporate family (same tax ID) 17

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

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

Facilities with the same owner 5

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

Practitioners 60

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 60

Medicare participation

Medicare fee-for-service enrollment
Enrolled in WA

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
Corporation · Non-profit
Incorporated
Aug 19, 2003 in WA
Enrollment address
221 Professional Way
Shelton, WA 98584-4404
Related CCNs
501336

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 Officer
Ceo		 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

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 Clinic
Shelton, WA · CCN 508549		 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 22, 2008
Mason Health-Oakland Bay Primary Care
Shelton, 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 Clinic
Shelton, 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 Physicians
Shelton, WA · CCN 508564		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2013
Mason Health Hoodsport Primary Care
Hoodsport, WA · CCN 508566		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2014

Medicare enrollment records

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

National Provider Directory

Tax ID family
Public Hospital District No (18 organizations share this tax ID)

Specialties & licenses

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

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

  • Mason General Hospital Olympic Physicians Doing business as

Other providers in Shelton, WA

All providers in Shelton, WA · Rural Health Clinic/Center in Washington

Sources for this page

Verify at the official NPI Registry.