NPIMap

Organization Active NPI

Grant County Public Hospital District 1

Doing business as Samaritan Clinic on Patton

  • Rural Health Clinic/Center
  • Moses Lake, WA
National Provider Identifier
1609112739
Registry record updated Oct 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GRANT COUNTY PUBLIC HOSPITAL DISTRICT 1
Doing business as
Samaritan Clinic on Patton
Practice address
8420 Aspi Blvd
Moses Lake, WA 98837-1820
Phone
(509) 793-9781
Fax
(509) 764-3244
NPI assigned
Dec 18, 2012
Last updated
Oct 5, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
SAMARITAN HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 5, 2026

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

Authorized official

Name
Alexander Town
Title
Ceo
Phone
(509) 793-9600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

8420 Aspi Blvd
Moses Lake, WA 98837-1820

Mailing address

1616 S Pioneer Way
Moses Lake, WA 98837-2487
Phone (509) 793-9715

Other identifiers 1

IdentifierTypeStateIssuer
2028741MedicaidWA

Other names 1

  • Samaritan Clinic on Patton Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040227000602 WA Part B Supplier - Clinic/Group Practice 9931095692 Receives reassigned benefits from 160 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Moses Lake, WA
O20190926001711 WA Part A Provider - Rural Health Clinic 9931095692 Practice locations: Moses Lake, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609112739. Details of each certification follow.

Rural health clinic certification: CCN 508592

Legal name
GRANT COUNTY PUBLIC HOSPITAL DISTRICT 1
Doing business as
SAMARITAN CLINIC ON PATTON
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 15, 2020
Last certification
Jul 15, 2020
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
in WA
Enrollment address
8420 Aspi Blvd
Moses Lake, WA 98837-3601
Related CCNs
500033

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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
50D2168050Samaritan Clinic on Patton8420 Aspi Blvd, Moses Lake, WA 98837Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Part of
Samaritan Hospital

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

8420 Aspi Blvd
Moses Lake, WA 98837
Phone (509) 793-9781

8420 Aspi Blvd
Ste 1
Moses Lake, WA 98837
Phone (509) 793-9781

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
Alexander Town Individual Corporate OfficerCao Sep 1, 2017
W-2 Managing EmployeeCao Sep 1, 2019
Theresa Sullivan Individual Corporate OfficerCeo Jun 1, 2015
W-2 Managing EmployeeCeo Sep 1, 2019
Grant County Public Hospital District 1 Organization, Moses Lake, WA Non-profit 5% Or Greater Direct Ownership Interest Sep 1, 2019 100%

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Samaritan HospitalMoses Lake, WA, CCN 500033 Hospital Operational/Managerial Control Nov 27, 2007
Samaritan ClinicMoses Lake, WA, CCN 508536 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2004

Owned or controlled facilities with NPI records 2

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 150

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 150

NPI Registry JSON

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

{
    "created_epoch": "1355788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791158400000",
    "number": "1609112739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 S PIONEER WAY",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988372487",
            "telephone_number": "509-793-9715",
            "fax_number": "509-764-3244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8420 ASPI BLVD",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988371820",
            "telephone_number": "509-793-9781",
            "fax_number": "509-764-3244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANT COUNTY PUBLIC HOSPITAL DISTRICT 1",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAMARITAN HOSPITAL",
        "enumeration_date": "2012-12-18",
        "last_updated": "2026-10-05",
        "certification_date": "2026-10-05",
        "status": "A",
        "authorized_official_last_name": "TOWN",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-793-9600"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2028741",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Samaritan Clinic on Patton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moses Lake, WA

Sources for this page

Verify at the official NPI Registry.