NPIMap

Organization Active NPI

Public Hospital District 3 of Pacific County

  • Medicare Defined Swing Bed Hospital Unit
  • Ilwaco, WA
National Provider Identifier
1902074776
Registry record updated Mar 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
HO79 Issued in WA
Legal business name
PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY
Practice address
174 1St Avenue North
Ilwaco, WA 98624-0258
Phone
(360) 642-3181
Fax
(360) 642-6309
NPI assigned
Feb 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2019

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

Authorized official

Name
Larry Cohen
Title
Ceo
Phone
(360) 642-6300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X HO79 WA Primary

Addresses

Primary practice location

174 1St Avenue North
Ilwaco, WA 98624-0258

Mailing address

174 1St Avenue North
Ilwaco, WA 98624-0258
Phone (360) 642-3181

Other names 1

  • Ocean Beach Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080311000074 WA Part A Provider - Critical Access Hospital 7214822105 Practice locations: Ilwaco, WA

Hospital certification: CCN 50Z314

Legal name
PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY
Doing business as
OCEAN BEACH HOSPITAL
Organization structure
CorporationNon-profit
Enrollment address
174 1St Ave N
Ilwaco, WA 98624-9137
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).

National Provider Directory

National Provider Directory
Tax ID family
Pac Co Hosp DST Obh Uni4 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.

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
Public Hospital District 3 of Pacific County Organization, Ilwaco, WA Non-profit Operational/Managerial Control Feb 15, 2008
Merry-Ann J Keane Individual Corporate OfficerCeo Jan 1, 2024
W-2 Managing EmployeeCeo Jan 1, 2024
Eric Volk Individual Corporate OfficerChief Executive Officer Jun 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
Ocean Beach HospitalIlwaco, WA, CCN 501314 Hospital Operational/Managerial Control Nov 17, 2007
Ocean Beach Medical ClinicIlwaco, WA, CCN 503988 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 14, 1995
Naselle ClinicNaselle, WA, CCN 503984 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1994
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 28

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

View all 28

Affiliated clinicians 1

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

NPI Registry JSON

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

{
    "created_epoch": "1202947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552348800000",
    "number": "1902074776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "174 1ST AVENUE NORTH",
            "city": "ILWACO",
            "state": "WA",
            "postal_code": "986240258",
            "telephone_number": "360-642-3181",
            "fax_number": "360-642-6309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "174 1ST AVENUE NORTH",
            "city": "ILWACO",
            "state": "WA",
            "postal_code": "986240258",
            "telephone_number": "360-642-3181",
            "fax_number": "360-642-6309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-14",
        "last_updated": "2019-03-12",
        "status": "A",
        "authorized_official_last_name": "COHEN",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "360-642-6300"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "WA",
            "license": "HO79",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ocean Beach Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ocean Beach Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ilwaco, WA

Sources for this page

Verify at the official NPI Registry.