NPIMap

Organization Active NPI

Wallowa County Health Care District

Doing business as Wallowa Memorial Hospital

  • Critical Access Hospital
  • Enterprise, OR
National Provider Identifier
1558366229
Registry record updated Feb 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
14 0068 Issued in OR
Legal business name
WALLOWA COUNTY HEALTH CARE DISTRICT
Doing business as
Wallowa Memorial Hospital
Practice address
601 Medical Parkway
Enterprise, OR 97828-1167
Phone
(541) 426-3111
Fax
(541) 426-1901
NPI assigned
Jun 17, 2005
Last updated
Feb 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2023

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

Authorized official

Name
Joseph Matthew Wanner
Title
Chief Financial Officer
Phone
(541) 426-5460

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 14 0068 OR Primary
Ambulance 341600000X

Addresses

Primary practice location

601 Medical Parkway
Enterprise, OR 97828-1167

Mailing address

601 Medical Parkway
Enterprise, OR 97828-5124
Phone (541) 426-3111

Other identifiers 1

IdentifierTypeStateIssuer
214205MedicaidOR

Other names 1

  • Wallowa Memorial Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061104000217 OR Part A Provider - Critical Access Hospital 4183537566 Receives reassigned benefits from 24 practitioners
Practice locations: Enterprise, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1558366229. Details of each certification follow.

Hospital certification: CCN 381306

Legal name
WALLOWA COUNTY HEALTH CARE DISTRICT
Doing business as
WALLOWA MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Sep 17, 2001
Last certification
Jul 26, 2012
Beds
25
Ownership / control type
Hospital district or authority
Organization structure
GovernmentNon-profit
Incorporated
Jul 1, 1992 in OR
Enrollment address
601 Medical Parkway
Enterprise, OR 97828-5124
Main/Primary Hospital Location

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

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospital

Medicare Care Compare
Listed as
Wallowa Memorial HospitalCCN 381306 · 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
Tax ID family
Wallowa Cnty HLTH Care Dist8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Nicholas a Lunde Individual Corporate DirectorBoard Member Jul 1, 2009 20%
Matthew Perren Individual Corporate Officer Nov 1, 2023
W-2 Managing Employee Nov 1, 2023
Nancy Crenshaw Individual Corporate Director Jul 1, 2018
Wallowa County Health Care District Organization, Enterprise, OR Operational/Managerial Control Oct 2, 2003
Adrian Harguess Individual Corporate Director Nov 2, 2022
Susan Coleman Individual Corporate DirectorBoard Member Jul 1, 2011 20%
Katherine Loftus Individual Corporate Director Nov 26, 2007

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Wallowa County Health Care DistrictEnterprise, OR, CCN 38Z306 Hospital Operational/Managerial Control Oct 2, 2003
Wallowa Memorial Medical Clinic - EnterpriseEnterprise, OR, CCN 388528 Rural health clinic Operational/Managerial Control (100%) Jul 1, 2015
Wallowa Memorial Medical Clinic - WallowaWallowa, OR, CCN 388552 Rural health clinic Other (100%) Jan 1, 1966
Wallowa Memorial Medical Clinic - JosephJoseph, OR, CCN 388551 Rural health clinic Other (100%) Jan 1, 1966
Wallowa Memorial Medical Clinic - DowntownEnterprise, OR, CCN 388550 Rural health clinic Other (100%) Jan 1, 1966

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 25

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 25

Affiliated clinicians 113

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

View all 113

NPI Registry JSON

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677542400000",
    "number": "1558366229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 MEDICAL PARKWAY",
            "city": "ENTERPRISE",
            "state": "OR",
            "postal_code": "978285124",
            "telephone_number": "541-426-3111",
            "fax_number": "541-426-4095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 MEDICAL PARKWAY",
            "city": "ENTERPRISE",
            "state": "OR",
            "postal_code": "978281167",
            "telephone_number": "541-426-3111",
            "fax_number": "541-426-1901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLOWA COUNTY HEALTH CARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-17",
        "last_updated": "2023-02-28",
        "certification_date": "2023-02-28",
        "status": "A",
        "authorized_official_last_name": "WANNER",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "541-426-5460"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "OR",
            "license": "14  0068",
            "primary": true
        },
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "214205",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wallowa Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wallowa Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Enterprise, OR

Sources for this page

Verify at the official NPI Registry.