Public Hospital Dist No 1 Skagit
Organization Active NPI Rural Health Clinic/Center · Camano Island, WA
NPI 1508932427 · NPPES record last updated Jun 16, 2018
Key facts
- NPI
- 1508932427
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- PUBLIC HOSPITAL DIST NO 1 SKAGIT
- Practice address
- 127 N. East Camano Drive
Suite a
Camano Island, WA 98282 - Phone
- (360) 387-5398
- Fax
- (360) 629-1644
- NPI assigned
- Nov 24, 2006
- Organization subpart
- No
Authorized official
- Name
- Paul Ishizuka
- Title
- Cfo
- Phone
- (360) 814-5838
Owners & managing parties with NPI records 6
Owned or controlled facilities with NPI records 4
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 25
Related certifications (CCN) 1
Facilities with the same owner 4
Practitioners 321
-
Daniela Abreu, DO
-
Steven Benjamin Alcocer, PA-C
-
Aleisha S Allen, PA-C
-
Jared M Anderson, MD
-
Thea Jerusha Anderson, ARNP
-
Blake C Arney, PA-C
-
Aaron J Arnold, DO
-
Sandeep Bal, MD
-
James Barger, DO
-
Diana Bartlett, MSN
-
Michael T Barton, MD
-
Grace Bay, DO
-
Mallory Rose Beach, ARNP
-
Kyle Beel, P.A.-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Rural health clinic certification: CCN 508502
- Legal name
- PUBLIC HOSPITAL DIST NO 1 SKAGIT
- Doing business as
- CAMANO COMMUNITY HEALTH CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Nov 5, 1999
- Last certification
- Jul 2, 2025
- Ownership / control type
- Non-profit – church related
- Organization structure
- Other · Non-profit
- Incorporated
- Nov 11, 1954 in WA
- Enrollment address
- 127 NE Camano Dr
Ste a
Camano Island, WA 98282-8732 - Related CCNs
- 500003
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Frei Burton |
Corporate Officer |
Jan 1, 2019 | |
| Peter a Browning |
Corporate Officer |
Jan 1, 2017 | |
| Gary Shand |
Corporate Officer |
Jan 1, 2019 | |
| Jeffrey Miller |
Corporate Director | Jan 1, 2014 | |
| Bruce Lisser |
Corporate Director | Jan 1, 2014 | |
| Public Hospital Dist No 1 Skagit |
5% Or Greater Direct Ownership Interest | Jan 1, 2004 | |
| Brian Ivie |
W-2 Managing Employee |
Nov 1, 2017 | |
| Tamara Lynn Cesena |
W-2 Managing Employee |
Jan 9, 2023 |
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Skagit Valley Hospital |
Hospital | 5% Or Greater Direct Ownership Interest | Jan 1, 2004 |
| Cascade Valley Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2016 |
| Hospice of the Northwest |
Hospice | 5% Or Greater Direct Ownership Interest (50%) Operational/Managerial Control (50%) |
Apr 1, 2007 Apr 1, 2007 |
| Skagit Regional Health - Darrington Family Medicine |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031218001052 | WA | Part a Provider - Rural Health Clinic | 6800793522 | Practice locations: Camano Island, WA |
National Provider Directory
- Tax ID family
- Skagit Valley Hospital
Locations
127 NE Camano Dr
Camano Island, WA 98282
Phone (360) 387-0184
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
127 N. East Camano Drive
Suite a
Camano Island, WA 98282
Mailing address
1415 E Kincaid St
Mount Vernon, WA 98274-4126
Phone (360) 424-4111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102129 | Medicaid | WA |
Other names
- Camano Community Health Clinic
- Skagit Valley Hospital RHC
Other providers in Camano Island, WA
- Mark Dudley Phibbs
- Christine Allison Pitts
- Alicia Michelle Ponte
- Ray Finley Pope
- Zachary Robert Pope
- Carolyn Ann Raport
- Mark A Reed
- Remedy Physical Therapy and Wellness LLC
- Cher Riedel
- Barbara Anne Riffle
All providers in Camano Island, WA · Rural Health Clinic/Center in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.