NPIMap

Organization Active NPI

Public Hospital District No 2 Skagit County Washington

Doing business as Fidalgo Medical Associates at Island Hospital

  • Clinic/Center
  • Anacortes, WA
National Provider Identifier
1356591077
Registry record updated Jan 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PUBLIC HOSPITAL DISTRICT NO 2 SKAGIT COUNTY WASHINGTON
Doing business as
Fidalgo Medical Associates at Island Hospital
Practice address
1213 24TH St
Anacortes, WA 98221-2592
Phone
(360) 293-3101
Fax
(360) 588-1041
NPI assigned
Sep 30, 2008
Last updated
Jan 25, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2013

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

Authorized official

Name
Elise J Cutter
Title
Cfo
Phone
(360) 299-1301

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1213 24TH St
Anacortes, WA 98221-2592

Mailing address

1211 24TH St
Anacortes, WA 98221-2557
Phone (360) 299-1300

Other names 1

  • FIDALGO MEDICAL ASSOCIATES AT ISLAND 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
O20031121000440 WA Part B Supplier - Clinic/Group Practice 1153225198 Receives reassigned benefits from 177 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Anacortes, WA; Eastsound, WA
O20081211000836 WA Part A Provider - Rural Health Clinic 1153225198 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Anacortes, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356591077. Details of each certification follow.

Rural health clinic certification: CCN 508548

Legal name
PUBLIC HOSPITAL DISTRICT NO 2 SKAGIT COUNTY WASHINGTON
Doing business as
FIDALGO MEDICAL ASSOCIATES
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 1, 2008
Last certification
Jan 11, 2018
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
Nov 19, 1958 in WA
Enrollment address
1213 24TH St Ste 100
Anacortes, WA 98221-2595
Related CCNs
500007

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

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 3

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 2 Skagit County Washington Organization, Anacortes, WA Non-profit Operational/Managerial Control Jan 1, 2010
Jan Iversen Individual Corporate Officer Jan 1, 2010
Corporate Director Oct 1, 2008
Elise J Cutter Individual Corporate OfficerCfo Jan 1, 2013
Operational/Managerial ControlCfo Jan 1, 2013

Owners & managing parties with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 39

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 39

NPI Registry JSON

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

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359072000000",
    "number": "1356591077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 24TH ST",
            "city": "ANACORTES",
            "state": "WA",
            "postal_code": "982212557",
            "telephone_number": "360-299-1300",
            "fax_number": "360-299-1339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1213 24TH ST",
            "city": "ANACORTES",
            "state": "WA",
            "postal_code": "982212592",
            "telephone_number": "360-293-3101",
            "fax_number": "360-588-1041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HOSPITAL DISTRICT NO 2 SKAGIT COUNTY WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-30",
        "last_updated": "2013-01-25",
        "status": "A",
        "authorized_official_last_name": "CUTTER",
        "authorized_official_first_name": "ELISE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "360-299-1301"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FIDALGO MEDICAL ASSOCIATES AT ISLAND HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Anacortes, WA

Sources for this page

Verify at the official NPI Registry.