NPIMap

Organization Active NPI

Clallam County Public Hospital District No 1

Doing business as Forks Community Hospital

  • Critical Access Hospital
  • Forks, WA
National Provider Identifier
1891879680
Registry record updated May 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
H-054 Issued in WA
Legal business name
CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Doing business as
Forks Community Hospital
Practice address
530 Bogachiel Way
Forks, WA 98331-9120
Phone
(360) 374-6271
NPI assigned
Oct 25, 2006
Last updated
May 19, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2021

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

Authorized official

Name
Starla Daman
Title
Billing Manger
Phone
(360) 374-6271

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X H-054 WA Primary
Ambulance 341600000X

Addresses

Primary practice location

530 Bogachiel Way
Forks, WA 98331-9120

Mailing address

530 Bogachiel Way
Forks, WA 98331-9120
Phone (360) 374-6271

Other names 1

  • Forks Community Hospital Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040219000309 WA Part B Supplier - Clinic/Group Practice 1557256468 Receives reassigned benefits from 37 practitioners
4 other NPIs on this enrollment
Practice locations: Clallam Bay, WA; Forks, WA
O20051219000437 WA Part A Provider - Critical Access Hospital 1557256468 Receives reassigned benefits from 38 practitioners
Practice locations: Forks, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891879680. Details of each certification follow.

Hospital certification: CCN 501325

Legal name
CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Doing business as
FORKS COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 1, 2003
Last certification
Oct 16, 2025
Beds
45 (15 certified)
Ownership / control type
Hospital district or authority
Organization structure
OtherNon-profit
Enrollment address
530 Bogachiel Way
Forks, WA 98331-9120
Other Hospital Practice Location

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

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 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Forks Community HospitalCCN 501325 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Clallam Bay Medical Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Interoperability endpoints

  • Direct secure messaging: andrea@direct.forkshospital.org
  • Direct secure messaging: jamesf@direct.forkshospital.org
  • Direct secure messaging: jefferyw@direct.forkshospital.org
  • Direct secure messaging: johns@direct.forkshospital.org
  • Direct secure messaging: mcgtr@direct.forkshospital.org
  • Direct secure messaging: richardd@direct.forkshospital.org
  • Direct secure messaging: theom@direct.forkshospital.org
  • Direct secure messaging: walje@direct.forkshospital.org

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Sarah Huling Individual Corporate Director Jan 25, 2022
Clallam County Public Hospital District No 1 Organization, Forks, WA Operational/Managerial Control Oct 23, 2007
Paige Pearson Individual Corporate Director Nov 12, 2024
Donald Lawley Individual Corporate Director Oct 23, 2007
Carie Micheau Individual W-2 Managing Employee Nov 26, 2019
Charles Carlson Individual Corporate Director Jan 1, 2024
Heidi L Anderson Individual Corporate OfficerChief Executive Officer May 19, 2020
W-2 Managing Employee May 19, 2020
Paul Babcock Individual Corporate OfficerChief Financial Officer Jan 17, 2017
W-2 Managing Employee Jan 1, 2017
Amy Ruble Individual Corporate Director Jan 1, 2024

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
Forks Community HospitalForks, WA, CCN 50Z325 Hospital Operational/Managerial Control Oct 23, 2007
Clallam Bay Medical ClinicClallam Bay, WA, CCN 503975 Rural health clinic Operational/Managerial Control Jul 7, 2008
Bogachiel ClinicForks, WA, CCN 508520 Rural health clinic Operational/Managerial Control Aug 26, 2008
Forks Family Medical ClinicForks, WA, CCN 508591 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) May 1, 2012

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.

Subparts reporting this organization as parent 3

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 85

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 85

Affiliated clinicians 99

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

View all 99

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621382400000",
    "number": "1891879680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 BOGACHIEL WAY",
            "city": "FORKS",
            "state": "WA",
            "postal_code": "983319120",
            "telephone_number": "360-374-6271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 BOGACHIEL WAY",
            "city": "FORKS",
            "state": "WA",
            "postal_code": "983319120",
            "telephone_number": "360-374-6271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT NO 1",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A",
        "authorized_official_last_name": "DAMAN",
        "authorized_official_first_name": "STARLA",
        "authorized_official_title_or_position": "BILLING MANGER",
        "authorized_official_telephone_number": "360-374-6271"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "WA",
            "license": "H-054",
            "primary": true
        },
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Forks Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Forks Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Forks, WA

Sources for this page

Verify at the official NPI Registry.