NPIMap

Organization Active NPI

Prosser Public Hospital District of Benton County

Doing business as Prosser Clinic-Prosser Memorial Health

  • Rural Health Clinic/Center
  • Prosser, WA
National Provider Identifier
1477088391
Registry record updated Feb 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY
Doing business as
Prosser Clinic-Prosser Memorial Health
Practice address
336 Chardonnay Ave Ste a
Prosser, WA 99350
Phone
(509) 786-1576
Fax
(509) 786-1574
NPI assigned
Apr 28, 2017
Last updated
Feb 22, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 22, 2019

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

336 Chardonnay Ave Ste a
Prosser, WA 99350

Mailing address

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

Other names 1

  • Prosser Clinic-Prosser Memorial Health 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
O20170926001052 WA Part A Provider - Rural Health Clinic 6709787872 Practice locations: Prosser, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477088391. Details of each certification follow.

Rural health clinic certification: CCN 508582

Legal name
PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY
Doing business as
PROSSER PMH FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 10, 2018
Last certification
Sep 10, 2018
Ownership / control type
2B
Organization structure
OtherNon-profit
Incorporated
Dec 26, 1947 in WA
Enrollment address
336 Chardonnay Ave
Ste a
Prosser, WA 99350-9515
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
50D2131624Prosser PMH Family Medicine336 Chardonnay Ave BLDG a, Prosser, WA 99350Certificate of waiverApr 4, 2028
50D2284345Prosser Memorial Health - Prosser Clinic336 Chardonnay Ave Ste a, Prosser, WA 99350Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Prosser Memorial Hosp E7 organizations share this tax ID, including this one
Part of
Prosser Memorial Hosp E

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

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 Oct 19, 2020
Corporate DirectorBoard Member Commissioner Oct 19, 2020
Keith Sattler Individual Corporate OfficerBoard Member Commissioner Postio Jan 1, 2012
Corporate DirectorBoard Member Commissioner Postio Jan 1, 2012
Brandon Bowden Individual Corporate OfficerBoard Member Commissioner Aug 31, 2017
Corporate DirectorBoard Member Commissioner Aug 31, 2017
Glen Bestebreur Individual Corporate OfficerBoard Member Commissioner Postio Oct 28, 2010
Corporate DirectorBoard Member Commissioner Postio Oct 28, 2010
Prosser Public Hospital District of Benton County Organization, Prosser, WA 5% Or Greater Direct Ownership Interest May 15, 2017 100%
Stephen Kenny Individual Corporate OfficerBoard Member President Position Aug 13, 1984
Corporate DirectorBoard Member President Position 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 Position Mar 3, 2017
Corporate DirectorBoard Member Secretary Position Mar 3, 2017
David E Rollins Individual Corporate OfficerCeo Jul 1, 2019
Corporate DirectorCeo Jul 1, 2019

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 1

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

FacilityTypeRoleSince
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 1

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 44

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 44

NPI Registry JSON

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

{
    "created_epoch": "1493337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550793600000",
    "number": "1477088391",
    "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": "336 CHARDONNAY AVE STE A",
            "city": "PROSSER",
            "state": "WA",
            "postal_code": "99350",
            "telephone_number": "509-786-1576",
            "fax_number": "509-786-1574"
        }
    ],
    "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 COUNTY",
        "enumeration_date": "2017-04-28",
        "last_updated": "2019-02-22",
        "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": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prosser Clinic-Prosser Memorial Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prosser, WA

Sources for this page

Verify at the official NPI Registry.