San Juan Healthcare PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

SAN JUAN HEALTHCARE PC

Practice address

689 Airport Center Dr Suite B
Friday Harbor, WA 98250

Phone

(360) 378-1338

Fax

(360) 378-8130

NPI assigned

Jul 17, 2007

Last updated

Mar 4, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John Burk Gossom, MDNPI 1245221886

Title

Owner

Phone

(360) 378-1338

Specialties & licenses 2

Addresses

Other identifiers 16

Locations

Practitioners 5

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.

• John Burk Gossom, MD

  • Geriatric Medicine (Family Medicine) Physician
  • Friday Harbor, WA
  • NPI 1245221886
  Authorized official Same address or phone
• Caroline Louise Hansen, PA-C

  • Physician Assistant
  • Fresno, CA
  • NPI 1033280235
  NPD
• Jeffrey Robert Merrill, M. D.

  • Family Medicine Physician
  • Yakima, WA
  • NPI 1366776080
  NPD (past)
• Eileen Melody Cleveland, ARNP

  • Family Nurse Practitioner
  • Tigard, OR
  • NPI 1700049152
  NPD (past)
• Leslie R Mutchler, NP

  • Nurse Practitioner
  • Billings, MT
  • NPI 1720272347
  NPD (past)

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

{
    "created_epoch": "1184630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299196800000",
    "number": "1407055742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1550",
            "city": "FRIDAY HARBOR",
            "state": "WA",
            "postal_code": "982501550",
            "telephone_number": "360-378-1338",
            "fax_number": "360-378-1830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "689 AIRPORT CENTER DR SUITE B",
            "city": "FRIDAY HARBOR",
            "state": "WA",
            "postal_code": "98250",
            "telephone_number": "360-378-1338",
            "fax_number": "360-378-8130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JUAN HEALTHCARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-17",
        "last_updated": "2011-03-04",
        "status": "A",
        "authorized_official_last_name": "GOSSOM",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "BURK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-378-1338",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US CUSTOMAS & BORDER PROTECTION",
            "identifier": "612622200",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7135981",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH COOPERATIVE",
            "identifier": "748121",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7990344",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "PENDING",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DSHS",
            "identifier": "PENDING",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US NATL PARK SERVICE",
            "identifier": "612622200",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7138829",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRIME VICTIMS",
            "identifier": "8937841",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARKS NATL L&I",
            "identifier": "361929500",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBI",
            "identifier": "602732862",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "POO425655DG2646",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "J5122",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "50D0990556",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "0152516",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "9451SA",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• San Juan Counseling, PLLC
• San Juan County Health & Community Services
• San Juan County Health & Community Services
• San Juan County Public Hospital District No 1 (Inter Island Medical Center)
• San Juan Healthcare Associates PLLC
• San Juan Island Emergency Medical Service (San Juan Island EMS)
• San Juan Island School District
• San Juan Physical Therapy, Inc.
• Scott Hakon Schoultz, OTR/L
• Erin Schuldt, RN

• Primary Care Clinic/Center in Friday Harbor, WA
• Providers in Friday Harbor, WA by specialty
• Primary Care Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.