NPIMap

Organization Active NPI

Public Hospital District No 1 of Mason County Washington

  • Foot & Ankle Surgery Podiatrist
  • Shelton, WA
National Provider Identifier
1437486248
Registry record updated Oct 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
PUBLIC HOSPITAL DISTRICT NO 1 OF MASON COUNTY WASHINGTON
Practice address
1812 N 13TH St
Shelton, WA 98584
Phone
(360) 427-0366
NPI assigned
Nov 16, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2014

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

Authorized official

Name
Mr. Eric Moll
Title
Chief Executive Officer
Phone
(360) 427-9554

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X Primary

Addresses

Primary practice location

1812 N 13TH St
Shelton, WA 98584

Mailing address

1812 N 13TH St
Shelton, WA 98584
Phone (360) 427-0366

Other names 1

  • Mason General Hospital Ankle Foot Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050106000705 WA Part A Provider - Critical Access Hospital 0345139275 Receives reassigned benefits from 52 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Shelton, WA

Hospital certification: CCN 501336

Legal name
PUBLIC HOSPITAL DISTRICT NO 1 OF MASON COUNTY
Doing business as
MASON GENERAL HOSPITAL & FAMILY OF CLINICS
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 1, 2005
Last certification
Jan 22, 2016
Beds
25
Ownership / control type
Hospital district or authority
Organization structure
GovernmentNon-profit
Enrollment address
901 Mt View Dr
Shelton, WA 98584-4401
Other Hospital Practice Location

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

Other NPIs on the same Medicare enrollment 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Mason General Hospital & Family of ClinicsCCN 501336
Overall star rating
2 of 5
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

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Eric C Moll Individual Corporate Director Jul 1, 2004
W-2 Managing Employee Jul 1, 2004
Stephen Leslie Individual W-2 Managing Employee Dec 31, 2022
Gayle Weston Individual Corporate Officer Nov 1, 2021
Darrin Moody Individual Corporate Officer Nov 1, 2021

Practitioners & affiliated clinicians

Affiliated clinicians 255

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

View all 255

NPI Registry JSON

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

{
    "created_epoch": "1258329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412121600000",
    "number": "1437486248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1812 N 13TH ST",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "98584",
            "telephone_number": "360-427-0366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1812 N 13TH ST",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "98584",
            "telephone_number": "360-427-0366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HOSPITAL DISTRICT NO 1 OF MASON COUNTY WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-16",
        "last_updated": "2014-10-01",
        "status": "A",
        "authorized_official_last_name": "MOLL",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "360-427-9554",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mason General Hospital Ankle Foot",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shelton, WA

Sources for this page

Verify at the official NPI Registry.