NPIMap

Organization Active NPI

Public Hospital District No 2, Klickitat County, Washington

Doing business as Skyline Hospital

  • Critical Access Hospital
  • White Salmon, WA
National Provider Identifier
1689779324
Registry record updated Jul 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
H-096 Issued in WA
Legal business name
PUBLIC HOSPITAL DISTRICT NO 2, KLICKITAT COUNTY, WASHINGTON
Doing business as
Skyline Hospital
Practice address
211 Skyline Drive
White Salmon, WA 98672
Phone
(509) 493-1101
Fax
(509) 493-4607
NPI assigned
Sep 14, 2006
Last updated
Jul 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2022

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

Authorized official

Name
Robert Kimmes
Title
Ceo
Phone
(509) 493-1101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X H-096 WA Primary

Addresses

Primary practice location

211 Skyline Drive
White Salmon, WA 98672

Mailing address

PO Box 99
White Salmon, WA 98672
Phone (509) 493-1101

Other identifiers 1

IdentifierTypeStateIssuer
4209607MedicaidWA

Other names 1

  • Skyline Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120309000106 WA Part A Provider - Critical Access Hospital 4981592144 Receives reassigned benefits from 2 practitioners
Practice locations: White Salmon, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689779324. Details of each certification follow.

Hospital certification: CCN 50Z315

Legal name
PUBLIC HOSPITAL DISTRICT NO. 2, KLICKITAT COUNTY, WASHINGTON
Doing business as
SKYLINE HOSPITAL
Organization structure
OtherNon-profit
Enrollment address
211 NE Skyline Dr
White Salmon, WA 98672-1948
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Skyline Hospital4 organizations share this tax ID, including this one

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 8

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

NameRoleSinceShare
Paul Pennington Individual Corporate DirectorBoard Commissioner Jan 1, 2018 20%
Jonathan Blake Individual Corporate OfficerBoard Vice Chair Jan 1, 2013 20%
Corporate DirectorBoard Commissioner Jan 1, 2013 20%
Brenda a Schneider Individual W-2 Managing EmployeeCfo Aug 28, 2006 100%
Public Hospital District No. 2, Klickitat County, Washington Organization, White Salmon, WA 5% Or Greater Direct Ownership Interest Jan 1, 1966 100%
Operational/Managerial Control Jan 1, 1966 100%
Juliet C Pouillon Individual Corporate OfficerBoard Secretary Jan 1, 2016 20%
Corporate DirectorBoard Commissioner Jan 1, 2016 20%
Leslie Dewey Individual Corporate OfficerBoard Chairman Commissioner Jan 1, 2006 20%
Corporate DirectorCommissioner Jan 1, 2006 20%
Robert P Kimmes Individual W-2 Managing EmployeeCeo Jan 14, 2013 100%
Operational/Managerial ControlCeo Jan 14, 2013 100%
Ricky Knowles Individual 5% Or Greater Direct Ownership InterestBoard Commissioner May 3, 2019 20%
Corporate DirectorDirector May 3, 2019 20%

Owners & managing parties with NPI records 3

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
Skyline HospitalWhite Salmon, WA, CCN 501315 Hospital Operational/Managerial Control (100%) Jan 1, 1966
Skyline Medical ClinicWhite Salmon, WA, CCN 508573 Rural health clinic Operational/Managerial Control (100%) Jan 1, 2017

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 3

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.

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658102400000",
    "number": "1689779324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 99",
            "city": "WHITE SALMON",
            "state": "WA",
            "postal_code": "98672",
            "telephone_number": "509-493-1101",
            "fax_number": "509-493-4607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 SKYLINE DRIVE",
            "city": "WHITE SALMON",
            "state": "WA",
            "postal_code": "98672",
            "telephone_number": "509-493-1101",
            "fax_number": "509-493-4607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HOSPITAL DISTRICT NO 2, KLICKITAT COUNTY, WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A",
        "authorized_official_last_name": "KIMMES",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-493-1101"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "WA",
            "license": "H-096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4209607",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Skyline Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in White Salmon, WA

Sources for this page

Verify at the official NPI Registry.