NPIMap

Organization Active NPI

North Olympic Healthcare Network

  • Federally Qualified Health Center (FQHC)
  • Port Angeles, WA
National Provider Identifier
1700526852
Registry record updated Nov 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTH OLYMPIC HEALTHCARE NETWORK
Practice address
1026 E 1St Street
Port Angeles, WA 98362
Phone
(360) 452-7891
NPI assigned
Mar 29, 2022
Last updated
Nov 9, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTH OLYMPIC HEALTHCARE NETWORKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 9, 2023

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

Authorized official

Name
Beau Brown
Title
Chief Financial Officer
Phone
(360) 452-7891

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1026 E 1St Street
Port Angeles, WA 98362

Mailing address

240 W Front St, Suite a
Port Angeles, WA 98362-2609
Phone (360) 452-7891

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150827003168 WA Part B Supplier - Clinic/Group Practice 3779895396 Receives reassigned benefits from 39 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Port Angeles, WA
O20221102003104 WA Part A Provider - Federally Qualified Health Center (FQHC) 3779895396 Practice locations: Port Angeles, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700526852. Details of each certification follow.

Federally qualified health center certification: CCN 501018

Legal name
NORTH OLYMPIC HEALTHCARE NETWORK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 1, 2023
Last certification
Feb 1, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1026 E 1St St
Port Angeles, WA 98362-4020

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
North Olympic Healthcare Network6 organizations share this tax ID, including this one
Part of
North Olympic Healthcare Network

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Tom Sanford Individual Corporate OfficerBoard Member Jun 1, 2017
Joanne M Moss Individual Corporate OfficerBoard Member Aug 7, 2015
Stacy Ritchie Individual Corporate OfficerBoard Member Jun 1, 2017
William D Baccus Individual Corporate OfficerBoard Member Aug 7, 2015
Beau Brown Individual Corporate OfficerCfo Jan 1, 2018
Corporate DirectorCfo Jan 1, 2018
Allison Mahaney Individual Corporate OfficerBoard Member Jan 1, 2022
North Olympic Healthcare Network Organization, Port Angeles, WA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Dec 3, 2022 100%
5% Or Greater Mortgage Interest Dec 3, 2022 100%
5% Or Greater Security Interest Dec 3, 2022 100%
Janet Lucas Individual Corporate OfficerBoard Member Jan 1, 2022
Michael Scott Maxwell Individual Corporate DirectorCeo Aug 1, 2015
Operational/Managerial ControlCeo Aug 1, 2015
Catharine Copass Individual Corporate OfficerBoard Member Jan 1, 2022
Ruth Kuch Individual Corporate OfficerBoard Member Jan 1, 2022
David L Chance Individual Corporate OfficerBoard Member Aug 7, 2017
Luke P Robins Individual Corporate OfficerBoard Member Jun 1, 2017

Owners & managing parties with NPI records 5

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
North Olympic Healthcare NetworkPort Angeles, WA, CCN 941039 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
5% Or Greater Mortgage Interest (100%)
5% Or Greater Security Interest (100%)		 Mar 14, 2018
Mar 14, 2018
Mar 14, 2018
North Olympic Healthcare NetworkPort Angeles, WA, CCN 501083 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2026

Owned or controlled facilities with NPI records 3

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 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1648512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699488000000",
    "number": "1700526852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 W FRONT ST, SUITE A",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983622609",
            "telephone_number": "360-452-7891",
            "fax_number": "360-452-8087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1026 E 1ST STREET",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "98362",
            "telephone_number": "360-452-7891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH OLYMPIC HEALTHCARE NETWORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH OLYMPIC HEALTHCARE NETWORK",
        "enumeration_date": "2022-03-29",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "BEAU",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "360-452-7891"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Angeles, WA

Sources for this page

Verify at the official NPI Registry.