NPIMap

Organization Active NPI

Grays Harbor Community Hospital

Doing business as GHCH Aberdeen East Clinic

  • Internal Medicine Physician
  • Aberdeen, WA
National Provider Identifier
1518337104
Registry record updated Apr 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
GRAYS HARBOR COMMUNITY HOSPITAL
Doing business as
GHCH Aberdeen East Clinic
Practice address
1006 N H St
Aberdeen, WA 98520-2521
Phone
(360) 537-6496
NPI assigned
Sep 25, 2015
Last updated
Apr 18, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2018

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

Authorized official

Name
Antone J Eek
Title
Executive Director Revenue Cycle
Phone
(360) 581-5495

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

1006 N H St
Aberdeen, WA 98520-2521

Mailing address

915 Anderson Dr
Aberdeen, WA 98520-1006

Other identifiers 1

IdentifierTypeStateIssuer
100366800MedicaidWA

Other names 1

  • GHCH Aberdeen East Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180322000911 WA Part A Provider - Rural Health Clinic 3577462365 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Aberdeen, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1518337104. Details of each certification follow.

Rural health clinic certification: CCN 508576

Legal name
GRAYS HARBOR COMMUNITY HOSPITAL
Doing business as
GHCH ABERDEEN EAST CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 16, 2018
Last certification
Aug 13, 2014
Ownership / control type
1B
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1939 in WA
Enrollment address
1006 N H St
Aberdeen, WA 98520-2521
Related CCNs
500031

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

1006 N H St
Aberdeen, WA 98520
Phone (360) 537-6032

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Thomas Jensen Individual Corporate OfficerCeo Apr 16, 2018
W-2 Managing EmployeeCeo Apr 16, 2018
Grays Harbor Community Hospital Organization, Aberdeen, WA Non-profit 5% Or Greater Direct Ownership Interest Apr 16, 2018 100%
Niall Shea Foley Individual Corporate OfficerChief Financial Officer Dec 1, 2018

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Change-of-ownership history 1

DateEventCounterparty
Apr 16, 2018 Change of OwnershipThis provider was the seller GHCH Aberdeen East ClinicCCN 508576, WA, NPI 1821573965

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

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

{
    "created_epoch": "1443139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524009600000",
    "number": "1518337104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 ANDERSON DR",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985201006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1006 N H ST",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985202521",
            "telephone_number": "360-537-6496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAYS HARBOR COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-25",
        "last_updated": "2018-04-18",
        "status": "A",
        "authorized_official_last_name": "EEK",
        "authorized_official_first_name": "ANTONE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR REVENUE CYCLE",
        "authorized_official_telephone_number": "360-581-5495"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100366800",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GHCH Aberdeen East Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GHCH Aberdeen East Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aberdeen, WA

Sources for this page

Verify at the official NPI Registry.