NPIMap

Organization Active NPI

Public Hospital District 3 of Pacific County

Doing business as Ocean Beach Medical Group -Ocean Park

  • Rural Health Clinic/Center
  • Ocean Park, WA
National Provider Identifier
1417482191
Registry record updated Mar 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
HAC.FS00000079 Issued in WA
Legal business name
PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY
Doing business as
Ocean Beach Medical Group -Ocean Park
Practice address
1501 Bay Ave
Suite 201
Ocean Park, WA 98640-4203
Phone
(360) 642-3747
NPI assigned
May 1, 2017
Last updated
Mar 12, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2019

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

Authorized official

Name
Larry Cohen
Title
Ceo
Phone
(360) 642-3181

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X HAC.FS00000079 WA Primary

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 1

  • Ocean Beach Medical Group -Ocean Park Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417482191. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Feb 6, 2002 in WA
Enrollment address
1501 Bay Ave
Ste 201
Ocean Park, WA 98640-4203
Related CCNs
501314

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).

Other NPIs on the same Medicare enrollment 5

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2141965Ocean Beach Medical Group Ocean Park1501 Bay Ave Ste 201, Ocean Park, WA 98640Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Locations

1501 Bay Ave
Ste 201
Ocean Park, WA 98640
Phone (360) 642-3747

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Julie Oakes Individual W-2 Managing EmployeeCompliance Officer-CHC-Certified Jan 26, 2017
Public Hospital District 3 of Pacific County Organization, Ilwaco, WA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2018 100%
Scot Attridge Individual Corporate OfficerCeo Aug 1, 2022
W-2 Managing EmployeeCeo Aug 1, 2022

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Ocean Beach HospitalIlwaco, WA, CCN 501314 Hospital Operational/Managerial Control Nov 17, 2007
Ocean Beach HospitalIlwaco, WA, CCN 50Z314 Hospital Operational/Managerial Control Feb 15, 2008
Ocean Beach Medical ClinicIlwaco, WA, CCN 503988 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 14, 1995
Naselle ClinicNaselle, WA, CCN 503984 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1994

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 31

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 31

NPI Registry JSON

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

{
    "created_epoch": "1493596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552348800000",
    "number": "1417482191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX N",
            "city": "ILWACO",
            "state": "WA",
            "postal_code": "986240319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 BAY AVE",
            "address_2": "SUITE 201",
            "city": "OCEAN PARK",
            "state": "WA",
            "postal_code": "986404203",
            "telephone_number": "360-642-3747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-01",
        "last_updated": "2019-03-12",
        "status": "A",
        "authorized_official_last_name": "COHEN",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "360-642-3181"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WA",
            "license": "HAC.FS00000079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ocean Beach Medical Group -Ocean Park",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ocean Beach Medical Group -Ocean Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ocean Park, WA

Sources for this page

Verify at the official NPI Registry.