Public Hospital District 3 of Pacific County
Organization Active NPI Rural Health Clinic/Center · Ocean Park, WA
NPI 1417482191 · NPPES record last updated Mar 12, 2019
Key facts
- NPI
- 1417482191
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- HAC.FS00000079 (WA)
- Legal business name
- PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY
- Practice address
- 1501 Bay Ave
Suite 201
Ocean Park, WA 98640-4203 - Phone
- (360) 642-3747
- NPI assigned
- May 1, 2017
- Organization subpart
- No
Authorized official
- Name
- Larry Cohen
- Title
- Ceo
- Phone
- (360) 642-3181
Owners & managing parties with NPI records 4
Owned or controlled facilities with NPI records 4
Other NPIs on the same Medicare enrollment 5
Other NPIs with the same Medicare PAC ID 4
Related certifications (CCN) 1
Facilities with the same owner 4
Practitioners 36
-
Steven L Bellinger, PA C
-
Albert O Fabiano, MD
-
April McCune, PA-C
-
Akashdeep Singh Sandhu, M.D.
-
James Caleb Bruce, D.O.
-
Emily S Darr, FNP
-
Lizabeth R Eller, MSW, LCSW
-
Carrie Jurkiewicz, M.D.
-
Kurt Colter Sawyer, APRN
-
Lynda K Williamson, D.O.
-
Landon Lewis, DNP
-
Laura McAbee, ARNP-BC
-
Lauren Eller, DPM
-
Gregory N Tjossem, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 50D2141965 | Ocean Beach Medical Group Ocean Park | Certificate of waiver | Apr 4, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WA
Rural health clinic certification: CCN 508578
- Legal name
- PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY
- Doing business as
- OCEAN BEACH MEDICAL GROUP - OCEAN PARK
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jun 22, 2018
- Last certification
- Jun 22, 2018
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Feb 6, 2002 in WA
- Enrollment address
- 1501 Bay Ave
Ste 201
Ocean Park, WA 98640-4203 - Related CCNs
- 501314
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Julie Oakes |
W-2 Managing Employee |
Jan 26, 2017 | |
| Public Hospital District 3 of Pacific County |
5% Or Greater Direct Ownership Interest | Jan 1, 2018 | 100% |
| Scot Attridge |
Corporate Officer |
Aug 1, 2022 | |
| W-2 Managing Employee |
Aug 1, 2022 |
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Ocean Beach Hospital |
Hospital | Operational/Managerial Control | Nov 17, 2007 |
| Ocean Beach Hospital |
Hospital | Operational/Managerial Control | Feb 15, 2008 |
| Ocean Beach Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Mar 14, 1995 |
| Naselle Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 1994 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040219000157 | WA | Part B Supplier - Clinic/Group Practice | 7214822105 |
Receives reassigned benefits from 33 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Ilwaco, WA; Long Beach, WA; Naselle, WA; Ocean Park, WA |
| O20171115003436 | WA | Part a Provider - Rural Health Clinic | 7214822105 | Practice locations: Ocean Park, WA |
National Provider Directory
Locations
1501 Bay Ave
Ste 201
Ocean Park, WA 98640
Phone (360) 642-3747
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | HAC.FS00000079 | WA | Yes |
Addresses
Primary practice location
1501 Bay Ave
Suite 201
Ocean Park, WA 98640-4203
Mailing address
PO Box N
Ilwaco, WA 98624-0319
Other names
- Ocean Beach Medical Group -Ocean Park
Other providers in Ocean Park, WA
- Kevin P McGinley
- Nathan King Miller
- Terri Miller
- Pacific County Fire Protection District 1
- Peninsula Pharmacies Inc.
- Real Talk Counseling, PLLC
- Regency Long Beach LLC
- David Lester Rodriguez II
- Leo Taylor
- Zachery Carl Wilson
All providers in Ocean Park, WA · Rural Health Clinic/Center in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 12, 2019. 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.