NPIMap

Organization Active NPI

Grant County Public Hospital District 1

Doing business as Samaritan Clinic

  • Rural Health Clinic/Center
  • Moses Lake, WA
National Provider Identifier
1619086766
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
Practice address
1550 S Pioneer Way Ste 115
Moses Lake, WA 98837-4618
Phone
(509) 793-9713
Fax
(509) 764-3244
NPI assigned
Aug 30, 2006
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 Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

1550 S Pioneer Way Ste 115
Moses Lake, WA 98837-4618

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
7109929MedicaidWA
1014658MedicaidWA
7063415MedicaidWA

Other names 1

  • Samaritan Clinic 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
Practice locations: Moses Lake, WA
O20040407001158 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 1619086766. Details of each certification follow.

Rural health clinic certification: CCN 508536

Legal name
GRANT COUNTY PUBLIC HOSPITAL DISTRICT 1
Doing business as
SAMARITAN CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 14, 2001
Last certification
Aug 19, 2014
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
in WA
Enrollment address
1550 S Pioneer Way
Ste 115
Moses Lake, WA 98837-4618
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
50D0875988Samaritan Clinic1550 S Pioneer Way, Suite 115, Moses Lake, WA 98837Provider-performed microscopyApr 4, 2028

National Provider Directory

National Provider Directory
Part of
Samaritan Healthcare

Locations

1550 S Pioneer Way
Moses Lake, WA 98837
Phone (509) 793-9780

1550 S Pioneer Way
Ste 115
Moses Lake, WA 98837
Phone 50979397154625

1550 S Pioneer Way
Ste 150
Moses Lake, WA 98837
Phone (509) 793-9780

1550 S Pioneer Way
Ste 165
Moses Lake, WA 98837
Phone (509) 793-9780

1550 S Pioneer Way
Ste 180
Moses Lake, WA 98837
Phone (509) 764-6532

1550 S Pioneer Way
Ste 220
Moses Lake, WA 98837
Phone (509) 793-9780

1550 S Pioneer Way
Ste 270
Moses Lake, WA 98837
Phone (509) 793-9794

1550 S Pioneer Way
Ste 300
Moses Lake, WA 98837
Phone (509) 793-9783

1550 S Pioneer Way
Ste 305
Moses Lake, WA 98837

1550 S Pioneer Way
Ste 365
Moses Lake, WA 98837
Phone (509) 764-6522

1550 S Pioneer Way
Ste 370
Moses Lake, WA 98837
Phone (509) 764-2928

1616 S Pioneer Way
Moses Lake, WA 98837

8420 Aspi Blvd
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 OfficerCfo Sep 1, 2017
W-2 Managing EmployeeCfo Sep 1, 2017
Theresa Sullivan Individual Corporate OfficerCeo Jun 1, 2015
Grant County Public Hospital District 1 Organization, Moses Lake, WA 5% Or Greater Direct Ownership Interest Apr 1, 2004 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 Clinic on PattonMoses Lake, WA, CCN 508592 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2019

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 183

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 183

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791158400000",
    "number": "1619086766",
    "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": "1550 S PIONEER WAY STE 115",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988374618",
            "telephone_number": "509-793-9713",
            "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": "2006-08-30",
        "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": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7109929",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1014658",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7063415",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Samaritan Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Samaritan Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moses Lake, WA

Sources for this page

Verify at the official NPI Registry.