NPIMap

Organization Active NPI

SHC Medical Center Toppenish

  • Rural Health Clinic/Center
  • Zillah, WA
National Provider Identifier
1659809457
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SHC MEDICAL CENTER TOPPENISH
Practice address
915 Vintage Valley Pkwy Ste 200
Zillah, WA 98953-9800
Phone
(509) 829-5151
NPI assigned
May 24, 2017
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mathew Mathiesen
Title
Cfo
Phone
(509) 837-1379

Other NPIs on the same Medicare enrollment 3

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

Other NPIs with the same Medicare PAC ID 2

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

Corporate family (same tax ID) 2

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

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

Facilities with the same owner 12

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 60

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

View all 60

Medicare participation

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

Rural health clinic certification: CCN 508581

Medicare enrollment files
Legal name
SHC MEDICAL CENTER TOPPENISH
Doing business as
ASTRIA HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 10, 2018
Last certification
Oct 10, 2018
Ownership / control type
2B
Most recent change of ownership
Jan 25, 2019 (1 total)
Organization structure
CorporationNon-profit
Enrollment address
1016 Tacoma Ave
Sunnyside, WA 98944-2263
Related CCNs
501330

All disclosed owners & managing parties 10

Medicare enrollment files

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

NameRoleSinceShare
Bertha Ortega Individual Corporate OfficerChairperson Jan 1, 2021
SHC Holdco LLC Organization, Sunnyside, WA LLC, Non-profit 5% Or Greater Direct Ownership Interest Sep 1, 2017 10%
Operational/Managerial Control Sep 1, 2017 10%
Brian P Gibbons Individual Corporate DirectorPresident & Ceo Jun 1, 2024
W-2 Managing EmployeePresident & Ceo Jun 1, 2024
Matthew Mathiesen Individual Corporate DirectorChief Financial Officer Jun 1, 2024
W-2 Managing EmployeeChief Financial Officer Jun 1, 2024
Carrie Story Individual Corporate OfficerVice Chairperson Jan 1, 2021
Maxine Janis Individual Corporate OfficerBoard Member Jan 1, 2021
Catherine Bambrick Individual Corporate DirectorAdministrator Oct 1, 2021
W-2 Managing EmployeeAdministrator Oct 1, 2021
Steven Young Individual Corporate OfficerBoard Member Jan 1, 2021
Maxwell Owens Individual Corporate OfficerCfo Jan 1, 2020
Corporate DirectorCfo Jan 1, 2020
W-2 Managing EmployeeCfo Jan 1, 2020
Astria Health Organization, Sunnyside, WA Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Sep 1, 2017 90%
Operational/Managerial Control Sep 1, 2017
Other Dec 31, 2018

Change-of-ownership history 2

Medicare enrollment files
DateEventCounterparty
Jan 25, 2019 Change of OwnershipThis provider was the buyer Vintage Valley Family MedCCN 508581, WA, NPI 1659809457
Jan 25, 2019 Change of OwnershipThis provider was the seller Astria HealthCCN 508581, WA, NPI 1659809457

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20171018001921 WA Part B Supplier - Hospital Department(S) 4082980065 Receives reassigned benefits from 81 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Toppenish, WA; Union Gap, WA; Yakima, WA; Zillah, WA
O20190109002710 WA Part a Provider - Rural Health Clinic 4082980065 Practice locations: Sunnyside, WA

National Provider Directory

National Provider Directory
Tax ID family
SHC Medical Center Toppenish (3 organizations share this tax ID)

Locations

1420 Ahtanum Ridge Dr
Union Gap, WA 98903
Phone (509) 454-7700

111 S 11th Ave
Yakima, WA 98902
Phone (509) 248-2321

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 600581630 WA
Rural Health Clinic/Center 261QR1300X Primary

Addresses

NPPES NPI Registry

Primary practice location

915 Vintage Valley Pkwy Ste 200
Zillah, WA 98953-9800

Mailing address

PO Box 719
Sunnyside, WA 98944-0719
Phone (509) 837-1617

Other names 1

NPPES NPI Registry
  • Vintage Valley Family Med Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 9, 2024.

{
    "created_epoch": "1495584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728432000000",
    "number": "1659809457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 719",
            "city": "SUNNYSIDE",
            "state": "WA",
            "postal_code": "989440719",
            "telephone_number": "509-837-1617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 VINTAGE VALLEY PKWY STE 200",
            "city": "ZILLAH",
            "state": "WA",
            "postal_code": "989539800",
            "telephone_number": "509-829-5151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHC MEDICAL CENTER TOPPENISH",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-24",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A",
        "authorized_official_last_name": "MATHIESEN",
        "authorized_official_first_name": "MATHEW",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "509-837-1379"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "600581630",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vintage Valley Family Med",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vintage Valley Family Med",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Zillah, WA

Sources for this page

Verify at the official NPI Registry.