NPIMap

Organization Active NPI

Jefferson County Public Hospital District No 2

Doing business as Jefferson Healthcare

  • Critical Access Hospital
  • Port Townsend, WA
National Provider Identifier
1356492953
Registry record updated Dec 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
282NC0060X Issued in WA
Legal business name
JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Doing business as
Jefferson Healthcare
Practice address
834 Sheridan St
Port Townsend, WA 98368-2443
Phone
(360) 385-2200
Fax
(360) 379-4381
NPI assigned
Jan 12, 2007
Last updated
Dec 31, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2025

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

Authorized official

Name
Mike Glenn
Title
Ceo
Phone
(360) 385-2200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
Critical Access Hospital 282NC0060X 282NC0060X WA Primary

Addresses

Primary practice location

834 Sheridan St
Port Townsend, WA 98368-2443

Mailing address

PO Box 104546
Pasadena, CA 91189-4546
Phone (360) 385-2200

Other practice location 1

1010 Sheridan St Ste 201
Port Townsend, WA 98368-2901
Phone (360) 385-5444

Other practice location 2

27 Colwell St
Port Hadlock, WA 98339-9701
Phone (360) 385-9310

Other identifiers 3

IdentifierTypeStateIssuer
3301900MedicaidWA
8865428OtherWAMEDICARE PTAN
7173404MedicaidWA

Other names 1

  • Jefferson Healthcare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, ID, AK, CO5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20031111000542 WA Part B Supplier - Clinic/Group Practice 4789593708 Receives reassigned benefits from 231 practitioners
9 other NPIs on this enrollment
Practice locations: Quilcene, WA; Port Townsend, WA; Port Ludlow, WA; Bellingham, WA
O20080304000166 WA Part A Provider - Critical Access Hospital 4789593708 Receives reassigned benefits from 177 practitioners
2 other NPIs on this enrollment
Practice locations: Port Townsend, WA
O20241016000970 ID Part B Supplier - Hospital Department(S) 4789593708 Receives reassigned benefits from 1 practitioner
Practice locations: Lewiston, ID
O20241021002273 AK Part B Supplier - Clinic/Group Practice 4789593708 Receives reassigned benefits from 3 practitioners
Practice locations: Eagle River, AK; Fairbanks, AK; Soldotna, AK
O20250729004175 CO Part B Supplier - Clinic/Group Practice 4789593708 Receives reassigned benefits from 1 practitioner
Practice locations: Aurora, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356492953. Details of each certification follow.

Hospital certification: CCN 501323

Legal name
JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Doing business as
JEFFERSON HEALTHCARE
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 1, 2003
Last certification
Apr 15, 2017
Beds
25
Ownership / control type
Hospital district or authority
Organization structure
CorporationProprietary
Incorporated
Jan 1, 1976 in WA
Enrollment address
834 Sheridan St
Port Townsend, WA 98368-2443
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 10

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Jefferson HealthcareCCN 501323 · All quality measures
Overall star rating
3 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

Locations

27 Colwell St
Port Hadlock, WA 98339
Phone (360) 385-9310

89 Breaker Ln
Port Ludlow, WA 98365
Phone (360) 437-4158

9481 Oak Bay Rd
Port Ludlow, WA 98365
Phone (360) 379-2254

9481 Oak Bay Rd
Ste A
Port Ludlow, WA 98365
Phone (360) 379-2254

1200 W Sims Way
Ste C
Port Townsend, WA 98368
Phone (360) 385-6297

1274 7th St
#B
Port Townsend, WA 98368
Phone (360) 385-2905

834 Sheridan St
#B
Port Townsend, WA 98368
Phone (360) 385-2204

915 Sheridan St
Ste B103
Port Townsend, WA 98368
Phone (360) 379-8031

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
Bruce McComas Individual Corporate DirectorBoard of Commissioner Jan 1, 2018
Cornelis Kolff Individual Corporate DirectorBoard of Commissioner Jan 1, 2016
Tyler Freeman Individual Corporate OfficerCfo Jan 1, 2022
Operational/Managerial ControlCfo Jan 1, 2022
Brandie Manuel Individual Corporate OfficerChief Patient Care Officer Nov 12, 2020
Corporate DirectorChief Patient Care Officer Nov 12, 2020
Matthew W Ready Individual Corporate DirectorBoard of Commissioner Apr 1, 2014
Lawrence M Glenn Individual Corporate OfficerCeo Oct 4, 2010
Corporate DirectorCeo Apr 1, 2014
Operational/Managerial ControlCeo Apr 1, 2014
Jill E Buhler Individual Corporate DirectorBoard of Commissioner Mar 2, 1995
Marie L Dressler Individual Corporate DirectorBoard of Commissioner Jan 1, 2010

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Jefferson Healthcare Home HealthPort Townsend, WA, CCN 507050 Home health agency Operational/Managerial Control Jan 1, 2003
Jefferson Healthcare Home Health and HospicePort Townsend, WA, CCN 501538 Hospice Operational/Managerial Control Aug 5, 2010

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 248

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 248

Affiliated clinicians 399

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

View all 399

NPI Registry JSON

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767139200000",
    "number": "1356492953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 104546",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911894546",
            "telephone_number": "360-385-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "834 SHERIDAN ST",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983682443",
            "telephone_number": "360-385-2200",
            "fax_number": "360-379-4381"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1010 Sheridan St Ste 201",
            "address_purpose": "LOCATION",
            "city": "Port Townsend",
            "state": "WA",
            "postal_code": "983682901",
            "country_code": "US",
            "telephone_number": "360-385-5444",
            "fax_number": "360-385-5352",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "27 Colwell St",
            "address_purpose": "LOCATION",
            "city": "Port Hadlock",
            "state": "WA",
            "postal_code": "983399701",
            "country_code": "US",
            "telephone_number": "360-385-9310",
            "fax_number": "360-379-8826",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-12",
        "last_updated": "2025-12-31",
        "certification_date": "2025-12-31",
        "status": "A",
        "authorized_official_last_name": "GLENN",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "360-385-2200"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "WA",
            "license": "282NC0060X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3301900",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "8865428",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7173404",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Townsend, WA

Sources for this page

Verify at the official NPI Registry.