NPIMap

Organization Active NPI

Providence Health & Services Washington

Doing business as Providence Centralia Hospital

  • General Acute Care Hospital
  • Centralia, WA
National Provider Identifier
1376624981
Registry record updated May 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
PROVIDENCE HEALTH & SERVICES WASHINGTON
Doing business as
Providence Centralia Hospital
Practice address
914 S Scheuber Rd
Centralia, WA 98531
Phone
(360) 736-2803
NPI assigned
Oct 18, 2006
Last updated
May 5, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2025

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

Authorized official

Name
Donald Wayne Anderson Jr.
Title
Assistant Secretary for Enrollment
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X NU Primary

Addresses

Primary practice location

914 S Scheuber Rd
Centralia, WA 98531

Mailing address

PO Box 31001-4110
Pasadena, CA 91110-4110

Other identifiers 3

IdentifierTypeStateIssuer
PR9896OtherWAREGENCE OP PROVIDER NUMBE
105OtherWAPREMERA BLUE CROSS
PR5896OtherWAREGENCE IP PROVIDER NUMBE

Other names 1

  • Providence Centralia 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
O20040227000254 WA Part B Supplier - Clinic/Group Practice 9234048323 Receives reassigned benefits from 86 practitioners
4 other NPIs on this enrollment
Practice locations: Centralia, WA
O20041122001274 WA Part A Provider - Hospital 9234048323 Practice locations: Lacey, WA; Centralia, WA; Aberdeen, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376624981. Details of each certification follow.

Hospital certification: CCN 500019

Legal name
PROVIDENCE HEALTH & SERVICES WASHINGTON
Doing business as
PROVIDENCE CENTRALIA HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
May 9, 2025
Beds
191
Ownership / control type
Other
Organization structure
CorporationNon-profit
Incorporated
Feb 5, 1859 in WA
Enrollment address
914 S Scheuber Rd
Centralia, WA 98531-9027
Other Hospital Practice Location
Hospital subgroups
General

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Providence Centralia HospitalCCN 500019 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Other
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Providence Centralia HospitalCCN 50T019
Ownership
Non-profit
Certified
Jan 1, 1985

This is a unit of this hospital with its own CMS Certification Number. Care Compare reports it separately, and it has no NPI of its own. How units are connected

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 24

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

NameRoleSinceShare
Diane L Hejna Individual Corporate DirectorBoard Member Jul 1, 2016
Richard S Blair Individual Corporate DirectorBoard Member Jul 1, 2016
Marvin O'Quinn Individual Corporate DirectorBoard Member Jan 1, 2024
Linda Buck Individual Corporate DirectorBoard Member Jan 1, 2025
Marna Leonard Individual W-2 Managing EmployeeFinancial Executive Aug 12, 2024
Providence Health & Services - Washington Organization, Renton, WA Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2012
Operational/Managerial Control Jan 1, 2012
Mary E Lyons Individual Corporate DirectorBoard Member Jul 1, 2016
Phyllis M Hughes Individual Corporate OfficerBoard Member Jan 1, 2014
Rogelio Riojas Individual Corporate DirectorBoard Member Jan 1, 2025
James Martin Individual Corporate OfficerAssistant Treasurer Jan 13, 2023
Darin V Goss Individual W-2 Managing EmployeeChief Executive Aug 3, 2020
Charles Wallace Sorenson Individual Corporate DirectorBoard Member Jan 1, 2019
Donald Wayne Anderson Individual Corporate OfficerAssistant Secretary for Enrollment Jan 1, 2017
Gregory David Hoffman Individual Corporate OfficerEvp & Cfo / Treasurer Oct 1, 2020
Isiaah D Crawford Individual Corporate DirectorBoard Member Feb 1, 2012
Donna Markham Individual Corporate DirectorBoard Member Jan 1, 2024
Michael W Murphy Individual Corporate DirectorBoard Member Jan 1, 2020
Providence Health & Services Organization, Renton, WA Non-profit Other Jul 1, 2016
Mary Beth Kingston Individual Corporate DirectorPSJH Board of Directors Sep 1, 2022
Eric D Sprunk Individual Corporate DirectorBoard Member Jan 1, 2022
Anna R Newsom Individual Corporate Officer May 13, 2022
Darryl Elmouchi Individual Corporate OfficerPresident & Ceo Apr 1, 2025
Karin Dufault Individual Corporate DirectorBoard Member Jan 1, 2025
Providence St. Joseph Health Organization, Renton, WA Non-profit Other Jul 1, 2016

Owners & managing parties with NPI records 1

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

Facilities with the same owner 139

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

View all 139

Practitioners & affiliated clinicians

Practitioners 133

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 133

Affiliated clinicians 528

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

View all 528

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746403200000",
    "number": "1376624981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-4110",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 S SCHEUBER RD",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "98531",
            "telephone_number": "360-736-2803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2025-05-05",
        "certification_date": "2025-05-05",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY FOR ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE OP PROVIDER NUMBE",
            "identifier": "PR9896",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMERA BLUE CROSS",
            "identifier": "105",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE IP PROVIDER NUMBE",
            "identifier": "PR5896",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Centralia Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Centralia Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centralia, WA

Sources for this page

Verify at the official NPI Registry.