NPIMap

Organization Active NPI

Grant County Public Hospital District No 5

  • Federally Qualified Health Center (FQHC)
  • Mattawa, WA
National Provider Identifier
1609410075
Registry record updated Jun 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GRANT COUNTY PUBLIC HOSPITAL DISTRICT NO 5
Practice address
101 S William Ave
Mattawa, WA 99349-0104
Phone
(509) 932-4499
Fax
(509) 932-5363
NPI assigned
Oct 29, 2019
Organization subpart
Yes
Parent organization
GRANT COUNTY PUBLIC HOSPITAL DISTRICT NO. 5As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 4, 2025

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

Authorized official

Name
Dana S Fox
Title
Ceo
Phone
(509) 932-4499

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

101 S William Ave
Mattawa, WA 99349-0104

Mailing address

210 Government Rd
Mattawa, WA 99349-5116
Phone (509) 932-4499

Other identifiers 1

IdentifierTypeStateIssuer
1699720797MedicaidWA

Other names 1

  • Mattawa Community Medical Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL MATTAWA Other Grant County Public Hospital District 5

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040401001562 WA Part B Supplier - Clinic/Group Practice 3274525837 Receives reassigned benefits from 11 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mattawa, WA
O20240611004556 WA Part A Provider - Federally Qualified Health Center (FQHC) 3274525837 1 other NPI on this enrollment
Practice locations: Mattawa, WA

Federally qualified health center certification: CCN 501055

Legal name
GRANT COUNTY PUBLIC HOSPITAL DISTRICT NO 5
Doing business as
MATTAWA COMMUNITY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 22, 2024
Last certification
May 22, 2024
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jan 5, 2010 in WA
Enrollment address
101 S William Ave
Mattawa, WA 99349-0104

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.

National Provider Directory

National Provider Directory
Tax ID family
Grant County Public Hospital District 54 organizations share this tax ID, including this one
Part of
Grant County Public Hospital District 5

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Grant County Public Hospital District No 5 Organization, Mattawa, WA Non-profit 5% Or Greater Direct Ownership Interest Jan 16, 2020 100%
Dana Fox Individual Corporate OfficerChief Executive Officer Aug 1, 2006 100%
W-2 Managing EmployeeAd;Ceo Aug 1, 2006 100%
Operational/Managerial ControlCeo Aug 1, 2006 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
Mattawa Community Medical ClinicMattawa, WA, CCN 501944 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 1, 1984
Mattawa Community Medical ClinicMattawa, WA, CCN 501051 Federally qualified health center 5% Or Greater Direct Ownership Interest Nov 1, 2023

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 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1572307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748995200000",
    "number": "1609410075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 GOVERNMENT RD",
            "city": "MATTAWA",
            "state": "WA",
            "postal_code": "993495116",
            "telephone_number": "509-932-4499",
            "fax_number": "509-932-5363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S WILLIAM AVE",
            "city": "MATTAWA",
            "state": "WA",
            "postal_code": "993490104",
            "telephone_number": "509-932-4499",
            "fax_number": "509-932-5363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANT COUNTY PUBLIC HOSPITAL DISTRICT NO 5",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRANT COUNTY PUBLIC HOSPITAL DISTRICT NO. 5",
        "enumeration_date": "2019-10-29",
        "last_updated": "2025-06-04",
        "certification_date": "2025-06-04",
        "status": "A",
        "authorized_official_last_name": "FOX",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-932-4499"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1699720797",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "MATTAWA",
            "affiliation": "Y",
            "affiliationName": "Grant County Public Hospital District 5",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "MATTAWA",
            "address_1": "210 Government Road",
            "city": "Mattawa",
            "state": "WA",
            "country_code": "US",
            "postal_code": "99349",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Mattawa Community Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mattawa Community Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mattawa, WA

Sources for this page

Verify at the official NPI Registry.