Grant County Public Hospital District 1
Organization Active NPI Rural Health Clinic/Center · Moses Lake, WA
NPI 1619086766 · NPPES record last updated Mar 7, 2026
Key facts
- NPI
- 1619086766
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- GRANT COUNTY PUBLIC HOSPITAL DISTRICT 1
- 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
- Organization subpart
- Yes
- Parent organization (as reported)
- SAMARITAN HOSPITAL
Authorized official
- Name
- Mrs. Theresa Sullivan
- Title
- Ceo
- Phone
- (509) 765-5606
Owners & managing parties with NPI records 2
Owned or controlled facilities with NPI records 2
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 2
Related certifications (CCN) 1
Facilities with the same owner 2
Practitioners 199
-
Billy Edward Albertson, CRNA
-
Arezou Amidi, DPM
-
Erik A Arnits, D.O
-
Elizabeth Bonadies, CNM
-
Eric J Bowton, M.D.
-
Phillip Carron, M.D.
-
M. Lyndon Dieter, MD
-
Hillary Nicole Dorsey, CRNA
-
Kameron Reza Firouzi, M.D.
-
Lance R Fredrickson, CRNA
-
Amanda Nicole Froisland, FNP-C
-
Teresa Hutsell, PMHNP
-
Jonathan Ingram, PMHNP
-
Jesse Isenstadt, D.O.
-
Katie Kist, D.O.
-
Trisha Kruger, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 50D0875988 | Samaritan Clinic | Provider-performed microscopy | Apr 4, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WA
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
- Other · Non-profit
- Incorporated
- in WA
- Enrollment address
- 1550 S Pioneer Way
Ste 115
Moses Lake, WA 98837-4618 - Related CCNs
- 500033
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Alexander Town |
Corporate Officer |
Sep 1, 2017 | |
| W-2 Managing Employee |
Sep 1, 2017 | ||
| Theresa Sullivan |
Corporate Officer |
Jun 1, 2015 | |
| Grant County Public Hospital District 1 |
5% Or Greater Direct Ownership Interest | Apr 1, 2004 | 100% |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Samaritan Hospital |
Hospital | Operational/Managerial Control | Nov 27, 2007 |
| Samaritan Clinic on Patton |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Part of
- Association of Samarita
Locations
8420 Aspi Blvd
Ste 1
Moses Lake, WA 98837
Phone (509) 793-9781
1550 S Pioneer Way
Ste 300
Moses Lake, WA 98837
Phone (509) 793-9783
1550 S Pioneer Way
Ste 250
Moses Lake, WA 98837
Phone (509) 765-5605
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) 793-9733
1550 S Pioneer Way
Ste 365
Moses Lake, WA 98837
Phone (509) 764-6522
2000 S Clover Dr
Moses Lake, WA 98837
Phone (509) 765-5606
1550 S Pioneer Way
Ste 270
Moses Lake, WA 98837
Phone (509) 793-9794
1550 S Pioneer Way
Ste 205
Moses Lake, WA 98837
Phone (509) 762-9206
1550 S Pioneer Way
Ste 370
Moses Lake, WA 98837
Phone (509) 765-3143
1550 S Pioneer Way
Ste 100
Moses Lake, WA 98837
Phone (509) 765-6525
1550 S Pioneer Way
Ste 115
Moses Lake, WA 98837
Phone (509) 793-9713
1550 S Pioneer Way
Ste 305
Moses Lake, WA 98837
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1014658 | Medicaid | WA | |
| 7063415 | Medicaid | WA | |
| 7109929 | Medicaid | WA |
Other names
- Samaritan Clinic
Other providers in Moses Lake, WA
- Grant County Health District
- Grant County Medic One, Inc
- Grant County Prevention and Recovery Center
- Grant County Public Hospital District 1
- Grant County Public Hospital District 1
- Grant County Public Hospital District 1
- Grant Cty Fire Protecct Dist
- Finley Jay Grant
- Jalicia Chanel Green
- Brett A Greenburg
All providers in Moses Lake, WA · Rural Health Clinic/Center in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.