NPIMap

Organization Active NPI

Grant County Public Hospital District No. 3

Doing business as Columbia Basin Family Medicine Clinic

  • Family Medicine Physician
  • Ephrata, WA
National Provider Identifier
1699839472
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GRANT COUNTY PUBLIC HOSPITAL DISTRICT NO. 3
Doing business as
Columbia Basin Family Medicine Clinic
Practice address
220 Nat Washington Way
Ephrata, WA 98823-1982
Phone
(509) 754-3330
Fax
(509) 754-2351
NPI assigned
Dec 19, 2006
Last updated
Sep 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Authorized official

Name
Rosalinda Kibby, CEO
Title
Administrator
Phone
(509) 754-4631

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X WA Primary

Addresses

Primary practice location

220 Nat Washington Way
Ephrata, WA 98823-1982

Mailing address

220 Nat Washington Way
Ephrata, WA 98823-1982
Phone (509) 754-3330

Other identifiers 1

IdentifierTypeStateIssuer
7043102MedicaidWA

Other names 1

  • Columbia Basin Family Medicine Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040313000538 WA Part B Supplier - Clinic/Group Practice 8325937675 Receives reassigned benefits from 21 practitioners
Practice locations: Ephrata, WA

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Locations

220 Nat Washington Way
Ephrata, WA 98823
Phone (509) 754-3330

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695859200000",
    "number": "1699839472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 NAT WASHINGTON WAY",
            "city": "EPHRATA",
            "state": "WA",
            "postal_code": "988231982",
            "telephone_number": "509-754-3330",
            "fax_number": "509-754-6356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 NAT WASHINGTON WAY",
            "city": "EPHRATA",
            "state": "WA",
            "postal_code": "988231982",
            "telephone_number": "509-754-3330",
            "fax_number": "509-754-2351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANT COUNTY PUBLIC HOSPITAL DISTRICT NO. 3",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A",
        "authorized_official_last_name": "KIBBY",
        "authorized_official_first_name": "ROSALINDA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "509-754-4631",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7043102",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Columbia Basin Family Medicine Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Columbia Basin Family Medicine Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ephrata, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.