NPIMap

Organization Active NPI

Public Hospital District 3 of Pacific County

Doing business as Naselle Clinic

  • Rural Health Clinic/Center
  • Naselle, WA
National Provider Identifier
1881858140
Registry record updated Nov 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
HAC.FS.00000079 Issued in WA
Legal business name
PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY
Doing business as
Naselle Clinic
Practice address
309 Knappton Rd
Naselle, WA 98638-8632
Phone
(360) 484-7161
Fax
(360) 484-7181
NPI assigned
Jul 16, 2008
Last updated
Nov 17, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 17, 2021

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

Authorized official

Name
Mr. Larry Cohen
Title
Ceo
Phone
(360) 642-3181

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X HAC.FS.00000079 WA Primary

Addresses

Primary practice location

309 Knappton Rd
Naselle, WA 98638-8632

Mailing address

PO Box 188
21 North Valley Road
Naselle, WA 98638-0188
Phone (360) 484-7161

Other names 1

  • Naselle 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
O20040219000157 WA Part B Supplier - Clinic/Group Practice 7214822105 Receives reassigned benefits from 33 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ilwaco, WA; Long Beach, WA; Naselle, WA; Ocean Park, WA
O20041119000815 WA Part A Provider - Rural Health Clinic 7214822105 Practice locations: Naselle, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881858140. Details of each certification follow.

Rural health clinic certification: CCN 503984

Legal name
PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY
Doing business as
NASELLE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 23, 1991
Last certification
May 1, 2019
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Feb 6, 2002 in WA
Enrollment address
309 Knappton Rd
Naselle, WA 98638

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 5

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D0637546Naselle Clinic309 Knappton Rd, Naselle, WA 98638Provider-performed microscopyApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Public Hlthcare District 34 organizations share this tax ID, including this one
Part of
Public Hlthcare District 3

Other organizations with this tax ID 3

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

Locations

21 N Valley Rd
Naselle, WA 98638
Phone (360) 484-7161

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
Julie Oakes Individual W-2 Managing EmployeeCompliance Officer CHC-Certified Jan 26, 2017
Public Hospital District 3 of Pacific County Organization, Ilwaco, WA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 1994 100%
Scot Attridge Individual Corporate OfficerCeo Aug 1, 2022
W-2 Managing EmployeeCeo Aug 1, 2022

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Ocean Beach HospitalIlwaco, WA, CCN 501314 Hospital Operational/Managerial Control Nov 17, 2007
Ocean Beach HospitalIlwaco, WA, CCN 50Z314 Hospital Operational/Managerial Control Feb 15, 2008
Ocean Beach Medical ClinicIlwaco, WA, CCN 503988 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 14, 1995
Ocean Beach Medical Group - Ocean ParkOcean Park, WA, CCN 508578 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2018

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 9

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": "1216166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637107200000",
    "number": "1881858140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 188",
            "address_2": "21 NORTH VALLEY ROAD",
            "city": "NASELLE",
            "state": "WA",
            "postal_code": "986380188",
            "telephone_number": "360-484-7161",
            "fax_number": "360-484-7178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 KNAPPTON RD",
            "city": "NASELLE",
            "state": "WA",
            "postal_code": "986388632",
            "telephone_number": "360-484-7161",
            "fax_number": "360-484-7181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY",
        "enumeration_date": "2008-07-16",
        "last_updated": "2021-11-17",
        "certification_date": "2021-11-03",
        "status": "A",
        "authorized_official_last_name": "COHEN",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "360-642-3181",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WA",
            "license": "HAC.FS.00000079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Naselle Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Naselle Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Naselle, WA

Sources for this page

Verify at the official NPI Registry.