NPIMap

Organization Active NPI

Klickitat County Public Hospital District No 1

Doing business as Klickitat Valley Health

  • Critical Access Hospital
  • Goldendale, WA
National Provider Identifier
1386689487
Registry record updated Dec 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
202000768 Issued in WA
Legal business name
KLICKITAT COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Doing business as
Klickitat Valley Health
Practice address
310 S Roosevelt Ave
Goldendale, WA 98620-9201
Phone
(509) 773-4022
NPI assigned
Jun 20, 2006
Last updated
Dec 20, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2021

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

Authorized official

Name
Leslie Hiebert
Title
Ceo
Phone
(509) 773-4022

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X WA
Occupational Medicine Clinic/Center 261QX0100X
Critical Access Hospital 282NC0060X 202000768 WA Primary

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 names 1

  • KLICKITAT VALLEY HEALTH Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061104000262 WA Part A Provider - Critical Access Hospital 0648164269 Receives reassigned benefits from 128 practitioners
Practice locations: Goldendale, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386689487. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Jan 1, 1940 in WA
Enrollment address
310 S Roosevelt St
Goldendale, WA 98620-9201
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Klickitat Valley HospitalCCN 501316 · All quality measures
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
Tax ID family
Family Pracitice Clinic7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Larry Hoctor Individual Corporate Director Jan 15, 2020
Ronald Ihrig Individual Corporate Director Jan 3, 2022
Jonathan Hatfield Individual Corporate OfficerCeo Oct 7, 2023
W-2 Managing Employee Sep 6, 2005
Mary Pond Individual Corporate Director Jan 1, 2014
Crystal Scott Individual Corporate Director May 1, 2019
Mark Sigfrinius Individual Corporate Director Jan 1, 2014
Lori Groves Individual Corporate OfficerCfo Dec 1, 2020
W-2 Managing Employee Dec 1, 2020

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Klickitat Valley HealthGoldendale, WA, CCN 501539 Hospice Operational/Managerial Control Apr 4, 2005
KVH Family MedicineGoldendale, WA, CCN 508519 Rural health clinic Operational/Managerial Control Jan 1, 1986

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 149

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 149

Affiliated clinicians 93

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

View all 93

NPI Registry JSON

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639958400000",
    "number": "1386689487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 S ROOSEVELT AVE",
            "city": "GOLDENDALE",
            "state": "WA",
            "postal_code": "986209201",
            "telephone_number": "509-773-4022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 S ROOSEVELT AVE",
            "city": "GOLDENDALE",
            "state": "WA",
            "postal_code": "986209201",
            "telephone_number": "509-773-4022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KLICKITAT COUNTY PUBLIC HOSPITAL DISTRICT NO 1",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-20",
        "status": "A",
        "authorized_official_last_name": "HIEBERT",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-773-4022"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "WA",
            "license": null,
            "primary": false
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "WA",
            "license": "202000768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KLICKITAT VALLEY HEALTH",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "KLICKITAT VALLEY HEALTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Goldendale, WA

Sources for this page

Verify at the official NPI Registry.