NPIMap

Organization Active NPI

Kittitas County Public Hospital Dist 1

Doing business as KVH Family Medicine Ellensburg

  • Rural Health Clinic/Center
  • Ellensburg, WA
National Provider Identifier
1770711764
Registry record updated May 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Doing business as
KVH Family Medicine Ellensburg
Medical Arts Center Clinic
Practice address
100 E Jackson Ave
Ellensburg, WA 98926-3692
Phone
(509) 933-8777
Fax
(509) 933-8741
NPI assigned
Jun 29, 2009
Last updated
May 28, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
KITTITAS COUNTY PUBLIC HOSPITAL DIST 1As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 28, 2020

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

Authorized official

Name
Ms. Becky Littke
Title
Director Revenue Cycle
Phone
(509) 962-7424

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X H-140 WA
Rural Health Clinic/Center 261QR1300X WA Primary

Addresses

Primary practice location

100 E Jackson Ave
Ellensburg, WA 98926-3692

Mailing address

P.O. Box 799
Ellensburg, WA 98926
Phone (509) 933-8771

Other identifiers 3

IdentifierTypeStateIssuer
7114267MedicaidWA
HAC.FS.00000140OtherWAWASHINGTON STATE DEPARTMENT OF HEALTH CERTIFICATION NUMBER
0248379OtherWAL&I

Other names 2

  • KVH Family Medicine Ellensburg Doing business as
  • Medical Arts Center Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040213000046 WA Part B Supplier - Clinic/Group Practice 0547179608 Receives reassigned benefits from 176 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ellensburg, WA; Cle Elum, WA
O20100819000779 WA Part A Provider - Rural Health Clinic 0547179608 Practice locations: Ellensburg, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770711764. Details of each certification follow.

Rural health clinic certification: CCN 508553

Legal name
KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Doing business as
MEDICAL ARTS CENTER CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 1, 2009
Last certification
Mar 1, 2016
Ownership / control type
2A
Organization structure
OtherNon-profit
Incorporated
Apr 2, 2009 in WA
Enrollment address
100 E Jackson Ave
Ellensburg, WA 98926-3692
Related CCNs
501333

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Part of
Kittitas Co Pub Hos Dis 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

100 E Jackson Ave
Ellensburg, WA 98926
Phone (509) 574-6000

716 E Manitoba Ave
Ellensburg, WA 98926
Phone (509) 925-3151

Interoperability endpoints

  • Direct secure messaging: astone@kittitasvalleyhealthcare.cernerdirect.com
  • Direct secure messaging: bherman@kittitasvalleyhealthcare.cernerdirect.com
  • Direct secure messaging: bwhite@kittitasvalleyhealthcare.cernerdirect.com
  • Direct secure messaging: jcasey@kittitasvalleyhealthcare.cernerdirect.com
  • Direct secure messaging: jelzinga-diaz@kittitasvalleyhealthcare.cernerdirect.com
  • Direct secure messaging: jiriel@kittitasvalleyhealthcare.cernerdirect.com
  • Direct secure messaging: jmerrillsteskal@kittitasvalleyhealthcare.cernerdirect.com
  • Direct secure messaging: kmartin@kittitasvalleyhealthcare.cernerdirect.com
  • Direct secure messaging: mlarson@kittitasvalleyhealthcare.cernerdirect.com

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Lisa Gott Individual W-2 Managing EmployeeDirector Revenue Cycle Operations Jan 1, 2024
Kittitas County Public Hospital Dist 1 Organization, Ellensburg, WA Operational/Managerial Control Nov 1, 1966 100%
Rhonda Holden Individual Corporate OfficerChief Nursing Officer Dec 9, 2009

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Kittitas Valley HealthcareEllensburg, WA, CCN 501333 Hospital Operational/Managerial Control (100%) Jan 1, 1966
Kittitas Valley HealthcareEllensburg, WA, CCN 50Z333 Hospital Operational/Managerial Control (100%) Jan 1, 2004
Kittitas Valley Healthcare Home HealthEllensburg, WA, CCN 507097 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 1964
Jan 1, 1964
Kittitas Valley Comm Hospital HospiceEllensburg, WA, CCN 501529 Hospice 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jul 25, 2008
Oct 3, 2011
Kittitas Valley Healthcare Family Medicine Cle ElumCle Elum, WA, CCN 508541 Rural health clinic Operational/Managerial Control (100%) Jul 1, 2005
Kittitas Valley Healthcare Internal MedicineEllensburg, WA, CCN 508545 Rural health clinic Operational/Managerial Control (100%) Jul 26, 2007

Owned or controlled facilities with NPI records 6

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

Facilities with the same owner 6

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

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590624000000",
    "number": "1770711764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 799",
            "city": "ELLENSBURG",
            "state": "WA",
            "postal_code": "98926",
            "telephone_number": "509-933-8771",
            "fax_number": "509-933-8692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E JACKSON AVE",
            "city": "ELLENSBURG",
            "state": "WA",
            "postal_code": "989263692",
            "telephone_number": "509-933-8777",
            "fax_number": "509-933-8741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KITTITAS COUNTY PUBLIC HOSPITAL DIST 1",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KITTITAS COUNTY PUBLIC HOSPITAL DIST 1",
        "enumeration_date": "2009-06-29",
        "last_updated": "2020-05-28",
        "certification_date": "2020-05-28",
        "status": "A",
        "authorized_official_last_name": "LITTKE",
        "authorized_official_first_name": "BECKY",
        "authorized_official_title_or_position": "DIRECTOR REVENUE CYCLE",
        "authorized_official_telephone_number": "509-962-7424",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "WA",
            "license": "H-140",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7114267",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON STATE DEPARTMENT OF HEALTH CERTIFICATION NUMBER",
            "identifier": "HAC.FS.00000140",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "0248379",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KVH Family Medicine Ellensburg",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medical Arts Center Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ellensburg, WA

Sources for this page

Verify at the official NPI Registry.