NPIMap

Organization Active NPI

Public Hospital Dist No 1 Skagit

  • Specialist
  • Mount Vernon, WA
National Provider Identifier
1629012463
Registry record updated Dec 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
H-073 Issued in WA
Legal business name
PUBLIC HOSPITAL DIST NO 1 SKAGIT
Practice address
307 S 13TH St Ste 100
Mount Vernon, WA 98274-4100
Phone
(360) 814-2146
Fax
(360) 428-2445
NPI assigned
Jun 15, 2006
Last updated
Dec 7, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2017

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

Authorized official

Name
Mr. Paul Ishizuka
Title
Cfo
Phone
(360) 814-5838

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X H-073 WA Primary

Addresses

Primary practice location

307 S 13TH St Ste 100
Mount Vernon, WA 98274-4100

Mailing address

307 S 13TH St
Suite 100
Mount Vernon, WA 98274-4100
Phone (360) 814-2146

Other identifiers 1

IdentifierTypeStateIssuer
1014836MedicaidWA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040309001059 WA Part B Supplier - Clinic/Group Practice 6800793522 Receives reassigned benefits from 550 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mount Vernon, WA; Oak Harbor, WA; Anacortes, WA; Stanwood, WA; Arlington, WA; Camano Island, WA; Darrington, WA; Everett, WA…
O20080506000040 WA Part B Supplier - Hospital Department(S) 6800793522 Receives reassigned benefits from 12 practitioners
Practice locations: Arlington, WA; Mount Vernon, WA

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Skagit Valley HospitalMount Vernon, WA, CCN 500003 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 2004
Cascade Valley HospitalArlington, WA, CCN 500060 Hospital 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2016
Hospice of the NorthwestMount Vernon, WA, CCN 501505 Hospice 5% Or Greater Direct Ownership Interest (50%)
Operational/Managerial Control (50%)		 Apr 1, 2007
Apr 1, 2007
Camano Community Health ClinicCamano Island, WA, CCN 508502 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 1, 2004
Skagit Regional Health - Darrington Family MedicineDarrington, WA, CCN 508509 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2016

Owned or controlled facilities with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 295

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 295

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512604800000",
    "number": "1629012463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 S 13TH ST",
            "address_2": "SUITE 100",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744100",
            "telephone_number": "360-814-2146",
            "fax_number": "360-428-2445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 S 13TH ST STE 100",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744100",
            "telephone_number": "360-814-2146",
            "fax_number": "360-428-2445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HOSPITAL DIST NO 1 SKAGIT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2017-12-07",
        "status": "A",
        "authorized_official_last_name": "ISHIZUKA",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "360-814-5838",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "H-073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1014836",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, WA

Sources for this page

Verify at the official NPI Registry.