NPIMap

Organization Active NPI

Prosser Public Hospital District of Benton County

Doing business as Benton City Clinic

  • Rural Health Clinic/Center
  • Benton City, WA
National Provider Identifier
1437199072
Registry record updated Apr 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
000056 Issued in WA
Legal business name
PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY
Doing business as
Benton City Clinic
Practice address
701 Dale Ave
Benton City, WA 99320-5250
Phone
(509) 588-4075
Fax
(509) 588-4197
NPI assigned
Jun 8, 2006
Last updated
Apr 8, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON CO.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 8, 2021

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

Authorized official

Name
Craig Marks
Title
Ceo
Phone
(509) 786-2222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 000056 WA Primary

Addresses

Primary practice location

701 Dale Ave
Benton City, WA 99320-5250

Mailing address

723 Memorial St
Prosser, WA 99350-1524
Phone (509) 786-2222

Other identifiers 4

IdentifierTypeStateIssuer
7600067MedicaidWA
7016165MedicaidWA
7064801MedicaidWA
0016909OtherWABCC L & I #

Other names 1

  • Benton City Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040120000974 WA Part B Supplier - Clinic/Group Practice 6709787872 Receives reassigned benefits from 248 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Walla Walla, WA; Prosser, WA; Grandview, WA; Benton City, WA
O20100622000300 WA Part A Provider - Rural Health Clinic 6709787872 Practice locations: Benton City, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437199072. Details of each certification follow.

Rural health clinic certification: CCN 508554

Legal name
PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY
Doing business as
BENTON CITY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 24, 2011
Last certification
Jan 16, 2018
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
Jan 1, 1960 in WA
Enrollment address
701 Dale Ave
Benton City, WA 99320-5250
Related CCNs
501312

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 8

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
50D2083660Benton City Clinic701 Dale Ave Ste a, Benton City, WA 99320Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Part of
Prosser Memorial Hosp C

Locations

1105 Dale Ave
Benton City, WA 99320
Phone (509) 588-4075

701 Dale Ave
Ste B
Benton City, WA 99320

336 Chardonnay Ave
#A
Prosser, WA 99350
Phone (509) 786-1576

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Neilan McPartland Individual Corporate OfficerBoard Member Commissioner Sep 7, 1980
Corporate DirectorBoard Member Commissioner Sep 7, 1980
Keith Sattler Individual Corporate OfficerBoard Member Commissioner Jan 1, 2012
Corporate DirectorBoard Member Commissioner Jan 1, 2012
Brandon Bowden Individual Corporate OfficerBoard Member Commissioner Sep 17, 2017
Corporate DirectorBoard Member Commissioner Sep 17, 2017
Glen Bestebreur Individual Corporate OfficerBoard Member Secretary Oct 28, 2010
Corporate DirectorBoard Member Secretary Oct 28, 2010
Stephen Kenny Individual Corporate OfficerBoard Member President Aug 13, 1984
Corporate DirectorBoard Member President Aug 13, 1984
Craig Marks Individual Corporate OfficerCeo Aug 29, 2016 100%
Corporate DirectorCeo Aug 29, 2016 100%
W-2 Managing EmployeeCeo Aug 29, 2016 100%
Operational/Managerial ControlCeo Aug 29, 2016 100%
Sharon a Dietrich Individual Corporate OfficerBoard Member Secretary Mar 3, 2014
Corporate DirectorBoard Member Secretary Mar 3, 2014
David E Rollins Individual Corporate OfficerCfo Jul 1, 2019

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Prosser PMH Family MedicineProsser, WA, CCN 508582 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) May 15, 2017
Prosser Memorial Health Grandview ClinicGrandview, WA, CCN 508588 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 7, 2019

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 95

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 95

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617840000000",
    "number": "1437199072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "723 MEMORIAL ST",
            "city": "PROSSER",
            "state": "WA",
            "postal_code": "993501524",
            "telephone_number": "509-786-2222",
            "fax_number": "509-786-6612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 DALE AVE",
            "city": "BENTON CITY",
            "state": "WA",
            "postal_code": "993205250",
            "telephone_number": "509-588-4075",
            "fax_number": "509-588-4197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON CO.",
        "enumeration_date": "2006-06-08",
        "last_updated": "2021-04-08",
        "certification_date": "2021-04-08",
        "status": "A",
        "authorized_official_last_name": "MARKS",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-786-2222"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WA",
            "license": "000056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7600067",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7016165",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7064801",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCC L & I #",
            "identifier": "0016909",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Benton City Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Benton City Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Benton City, WA

Sources for this page

Verify at the official NPI Registry.