Klickitat County Public Hospital District No 1
Organization Active NPI Critical Access Hospital · Goldendale, WA
NPI 1386689487 · NPPES record last updated Dec 20, 2021
Key facts
- NPI
- 1386689487
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- License
- 202000768 (WA)
- Legal business name
- KLICKITAT COUNTY PUBLIC HOSPITAL DISTRICT NO 1
- Practice address
- 310 S Roosevelt Ave
Goldendale, WA 98620-9201 - Phone
- (509) 773-4022
- NPI assigned
- Jun 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Leslie Hiebert
- Title
- Ceo
- Phone
- (509) 773-4022
Owned or controlled facilities with NPI records 2
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 6
Related certifications (CCN) 2
Practitioners 162
-
Rachel Velma Hampton, M.D.
-
Anusha Iyer, DPM
-
Shona Elizabeth Lowell, ARNP
-
Russell M Smith, MD
-
Peter G Andress, CRNA
-
Erin Rose Boehm, MD
-
Chad Lawrence Carr, M.D.
-
Ronald Chelsky, M.D.
-
Weichin Chen, MD
-
Jennifer Lee First, AGACNP-BC
-
Gail K. Jones, MD
-
Lauren Y Lee, M.D.
-
Hoang H Nguyen, MD
-
Aaron R Nott, DO
-
Eric T Riley, CRNA
-
Jeffrey Tanita, M.D.
-
Gerald G Yutzy, M.D.
-
Micky Patrick Cates, PA-C
-
James E. Bell I, MD
-
Tamela Cook-Mobley, APRN
-
Spencer John Drennan, PA-C
Affiliated clinicians 93
-
Dave S Atteberry, MD
-
Jeannette Dorothy Baars, PA-C
-
Todd John Baumeister, D.O.
-
Micky Patrick Cates, PA-C
-
Marcos G Chavez Jr., PAC
-
Lindsay Alison Drysdale, FNP-C, WHNP-BC
-
Kayla Elliott, PA-C
-
Joshua Grant, D.O.
-
Derek Greenwood, APRN
-
Yamac Gungor, MD
-
Rachel Velma Hampton, M.D.
-
Anusha Iyer, DPM
-
Tony T Lee, MD
-
Shona Elizabeth Lowell, ARNP
-
Chad R Magnuson, MD
-
Sara Elizabeth McBride, PA-C
-
Joel J Rhyner, PA-C
Medicare Care Compare: Hospital
- Listed as
- Klickitat Valley Hospital
- Type
- Critical Access Hospitals
- Ownership
- Government - Hospital District or Authority
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Hospital certification: CCN 501316
- Legal name
- KLICKITAT COUNTY PUBLIC HOSPITAL DISTRICT NO 1
- Doing business as
- KLICKITAT VALLEY HEALTH
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Apr 1, 2002
- Last certification
- Aug 13, 2021
- Beds
- 25
- Ownership / control type
- Hospital district or authority
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 1, 1940 in WA
- Enrollment address
- 310 S Roosevelt St
Goldendale, WA 98620-9201
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Larry Hoctor |
Corporate Director | Jan 15, 2020 | |
| Ronald Ihrig |
Corporate Director | Jan 3, 2022 | |
| Jonathan Hatfield |
Corporate Officer |
Oct 7, 2023 | |
| W-2 Managing Employee | Sep 6, 2005 | ||
| Mary Pond |
Corporate Director | Jan 1, 2014 | |
| Crystal Scott |
Corporate Director | May 1, 2019 | |
| Mark Sigfrinius |
Corporate Director | Jan 1, 2014 | |
| Lori Groves |
Corporate Officer |
Dec 1, 2020 | |
| W-2 Managing Employee | Dec 1, 2020 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Klickitat Valley Health |
Hospice | Operational/Managerial Control | Apr 4, 2005 |
| KVH Family Medicine |
Rural health clinic | Operational/Managerial Control | Jan 1, 1986 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061104000262 | WA | Part a Provider - Critical Access Hospital | 0648164269 |
Receives reassigned benefits from 128 practitioners Practice locations: Goldendale, WA |
National Provider Directory
- Tax ID family
- Family Pracitice Clinic
Locations
711 E Collins St
Goldendale, WA 98620
Phone (509) 773-4022
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | WA | ||
| Occupational Medicine Clinic/Center | 261QX0100X | |||
| Critical Access Hospital | 282NC0060X | 202000768 | WA | Yes |
Addresses
Primary practice location
310 S Roosevelt Ave
Goldendale, WA 98620-9201
Mailing address
310 S Roosevelt Ave
Goldendale, WA 98620-9201
Phone (509) 773-4022
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3304904 | Medicaid | WA |
Other names
- KLICKITAT VALLEY HEALTH
Other providers in Goldendale, WA
- Klickitat County Behavioral Health
- Klickitat County Emergency Medical Services No 1
- Klickitat County Health Department
- Klickitat County Public Hospital Dist No 1
- Klickitat County Public Hospital Dist No 1
- Klickitat County Public Hospital District No 1
- Klickitat County Public Hospital District No 1
- Klickitat County Public Hospital District No 1
- Klickitat County Public Hospital District No 1
- Klickitat County Public Hospital District No 1
All providers in Goldendale, WA · Critical Access Hospital in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 20, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.