NPIMap

Organization Active NPI

Jefferson County Public Hospital District No 2

Doing business as Sleep Medicine, Jefferson Healthcare

  • Sleep Medicine (Psychiatry & Neurology) Physician
  • Silverdale, WA
National Provider Identifier
1467664631
Registry record updated Oct 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084S0012X
License
3301900 Issued in WA
Legal business name
JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Doing business as
Sleep Medicine, Jefferson Healthcare
Practice address
9833 Poplars Ave NW Ste 104
Silverdale, WA 98383-7675
Phone
(360) 698-0422
Fax
(360) 698-0463
NPI assigned
May 3, 2007
Last updated
Oct 11, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2007

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

Authorized official

Name
Kathy L Porter
Title
Registration Coordinator
Phone
(360) 385-2200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Medicine (Psychiatry & Neurology) Physician 2084S0012X 3301900 WA Primary

Addresses

Primary practice location

9833 Poplars Ave NW Ste 104
Silverdale, WA 98383-7675

Mailing address

834 Sheridan Ave
Port Townsend, WA 98368-2443
Phone (360) 385-2200

Other identifiers 1

IdentifierTypeStateIssuer
3301900MedicaidWA

Other names 1

  • Sleep Medicine, Jefferson Healthcare Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031111000542 WA Part B Supplier - Clinic/Group Practice 4789593708 Receives reassigned benefits from 231 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Quilcene, WA; Port Townsend, WA; Port Ludlow, WA; Bellingham, WA
O20080304000166 WA Part A Provider - Critical Access Hospital 4789593708 Receives reassigned benefits from 177 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Port Townsend, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467664631. Details of each certification follow.

Hospital certification: CCN 501323

Legal name
JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Doing business as
JEFFERSON HEALTHCARE
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 1, 2003
Last certification
Apr 15, 2017
Beds
25
Ownership / control type
Hospital district or authority
Organization structure
CorporationProprietary
Incorporated
Jan 1, 1976 in WA
Enrollment address
834 Sheridan St
Port Townsend, WA 98368-2443
Other Hospital Practice Location

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

Other NPIs on the same Medicare enrollment 10

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Jefferson HealthcareCCN 501323 · All quality measures
Overall star rating
3 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 8

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

NameRoleSinceShare
Bruce McComas Individual Corporate DirectorBoard of Commissioner Jan 1, 2018
Cornelis Kolff Individual Corporate DirectorBoard of Commissioner Jan 1, 2016
Tyler Freeman Individual Corporate OfficerCfo Jan 1, 2022
Operational/Managerial ControlCfo Jan 1, 2022
Brandie Manuel Individual Corporate OfficerChief Patient Care Officer Nov 12, 2020
Corporate DirectorChief Patient Care Officer Nov 12, 2020
Matthew W Ready Individual Corporate DirectorBoard of Commissioner Apr 1, 2014
Lawrence M Glenn Individual Corporate OfficerCeo Oct 4, 2010
Corporate DirectorCeo Apr 1, 2014
Operational/Managerial ControlCeo Apr 1, 2014
Jill E Buhler Individual Corporate DirectorBoard of Commissioner Mar 2, 1995
Marie L Dressler Individual Corporate DirectorBoard of Commissioner Jan 1, 2010

Practitioners & affiliated clinicians

Affiliated clinicians 399

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

View all 399

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192060800000",
    "number": "1467664631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "834 SHERIDAN AVE",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983682443",
            "telephone_number": "360-385-2200",
            "fax_number": "360-379-2282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9833 POPLARS AVE NW STE 104",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "983837675",
            "telephone_number": "360-698-0422",
            "fax_number": "360-698-0463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2007-10-11",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "REGISTRATION COORDINATOR",
        "authorized_official_telephone_number": "360-385-2200"
    },
    "taxonomies": [
        {
            "code": "2084S0012X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": "WA",
            "license": "3301900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3301900",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sleep Medicine, Jefferson Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Silverdale, WA

Sources for this page

Verify at the official NPI Registry.