NPIMap

Organization Active NPI

Lower Elwha Klallam Tribe

  • Primary Care Clinic/Center
  • Port Angeles, WA
National Provider Identifier
1821114026
Registry record updated Mar 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
LOWER ELWHA KLALLAM TRIBE
Practice address
243511 W Highway 101
Port Angeles, WA 98363-9472
Phone
(360) 452-6252
Fax
(360) 452-6274
NPI assigned
Mar 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2022

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

Authorized official

Name
Frances G Charles
Title
Chairwoman
Phone
(360) 452-8471

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

243511 W Highway 101
Port Angeles, WA 98363-9472

Mailing address

243511 W Highway 101
Port Angeles, WA 98363-9472
Phone (360) 452-6252

Other identifiers 1

IdentifierTypeStateIssuer
50-1835OtherWAPTAN

Other names 1

  • Lower Elwha Klallam Tribe Health 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
O20040517000588 WA Part B Supplier - Clinic/Group Practice 0446240964 Receives reassigned benefits from 2 practitioners
Practice locations: Port Angeles, WA
O20091007000196 WA Part A Provider - Federally Qualified Health Center (FQHC) 0446240964 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Port Angeles, WA

Federally qualified health center certification: CCN 501835

Legal name
LOWER ELWHA KLALLAM TRIBE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 3, 1995
Last certification
Apr 3, 1995
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
243511 Hwy 101 West
Port Angeles, WA 98363-9472

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

243511 Highway 101
#C
Port Angeles, WA 98363

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
Lower Elwha Klallam Tribe Organization, Port Angeles, WA Non-profit Operational/Managerial Control Jun 7, 2004
Yolonda Zuniga Individual W-2 Managing EmployeeBilling Manager Jul 9, 2019
Frances Charles Individual Corporate Director Jun 7, 2004
W-2 Managing Employee Jun 7, 2004

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Lower Elwha Klallam TribePort Angeles, WA, CCN 501835 Federally qualified health center Operational/Managerial Control Jun 7, 2004

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647475200000",
    "number": "1821114026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "243511 W HIGHWAY 101",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983639472",
            "telephone_number": "360-452-6252",
            "fax_number": "360-452-6274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "243511 W HIGHWAY 101",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983639472",
            "telephone_number": "360-452-6252",
            "fax_number": "360-452-6274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOWER ELWHA KLALLAM TRIBE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2022-03-17",
        "certification_date": "2022-03-17",
        "status": "A",
        "authorized_official_last_name": "CHARLES",
        "authorized_official_first_name": "FRANCES",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CHAIRWOMAN",
        "authorized_official_telephone_number": "360-452-8471"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "50-1835",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lower Elwha Klallam Tribe Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lower Elwha Klallam Tribe Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Angeles, WA

Sources for this page

Verify at the official NPI Registry.