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Grays Harbor County Public Hospital District No 1

Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Elma, WA

NPI 1750554366 · NPPES record last updated Jan 24, 2013

Key facts

NPI
1750554366
Entity type
Organization (NPI type 2)
Primary specialty
Medicare Defined Swing Bed Hospital Unit 275N00000X
License
H-186 (WA)
Legal business name
GRAYS HARBOR COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Practice address
600 E. Main Street
Elma, WA 98541
Phone
(360) 495-3244
Fax
(360) 495-4274
NPI assigned
Apr 4, 2008
Organization subpart
No

Authorized official

Name
Ms. Renee K Jensen
Title
Ceo
Phone
(360) 495-3244

Owners & managing parties with NPI records 6

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 4

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

Other NPIs on the same Medicare enrollment 5

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

Other NPIs with the same Medicare PAC ID 5

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

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

Facilities with the same owner 4

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

Practitioners 74

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

View all 74

Affiliated clinicians 2

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in WA

Hospital certification: CCN 50Z304

Legal name
GRAYS HARBOR COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Doing business as
SUMMIT PACIFIC MEDICAL CENTER - SWING BED UNIT
Organization structure
Other · Non-profit
Incorporated
Jan 1, 1982 in WA
Enrollment address
600 E Main St
Elma, WA 98541-9560
Hospital Swing-Bed Unit

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
Georgette Hiles
Individual 		Corporate Director
Commissioner		 Jan 1, 2020 5%
Kenneth Dietrich
Individual 		Corporate Officer
Chief Medical Officer		 Mar 22, 2018 75%
Lynn Fifield
Individual 		W-2 Managing Employee
Medical Staff Program Coordinator		 Mar 10, 2015 5%
Andrew T Hooper
Individual 		Corporate Director
Board Member Position 1		 Jan 1, 2008
Joshua Martin
Individual 		Corporate Officer Apr 10, 2017 75%
Cheryl J Cornwell
Individual 		Corporate Officer
Chief Financial Officer		 May 1, 2025
Gary Thumser
Individual 		Corporate Director
Board Member Position 3		 Jan 1, 2014
Grays Harbor County Public Hospital District No 1
Organization · Elma, WA
Non-profit 		Operational/Managerial Control Feb 18, 2013 100%

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Summit Pacific Medical Center
Elma, WA · CCN 501304		 Hospital Operational/Managerial Control (5%) Jul 1, 1985
McCleary Healthcare Clinic
McCleary, WA · CCN 503998		 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 May 17, 2010
May 17, 2010
Summit Pacific Healthcare Clinic
Elma, WA · CCN 508560		 Rural health clinic Operational/Managerial Control Feb 18, 2013
Summit Pacific Health Clinic
Elma, WA · CCN 508596		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2021

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031226000146 WA Part B Supplier - Clinic/Group Practice 9032017256 Receives reassigned benefits from 158 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Elma, WA; McCleary, WA
O20080422000913 WA Part a Provider - Critical Access Hospital 9032017256 Practice locations: Elma, WA

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X H-186 WA Yes

Addresses

Primary practice location

600 E. Main Street
Elma, WA 98541

Mailing address

600 E. Main Street
Elma, WA 98541
Phone (360) 495-3244

Other identifiers

IdentifierTypeStateIssuer
QMXPR0048030OtherWAMOLINA H/O
18091OtherWAL&I ER FACILITY
CD1667OtherWARAILROAD MEDICARE
135OtherWAPREMERA
7257108MedicaidWA
8903272OtherWACRIME VICTIMS
GR6577OtherWAREGENCE BLUE SHEILD
18090OtherWAL&I ER DOC NUMBER
3147709MedicaidWA
G000800088OtherWAMEDICARE PRO FEE

Other names

  • Summit Pacific Medical Center Doing business as

Other providers in Elma, WA

All providers in Elma, WA · Medicare Defined Swing Bed Hospital Unit in Washington

Sources for this page

Verify at the official NPI Registry.