NPIMap

Organization Active NPI

Public Hospital District No 1 of Mason County Washington

Doing business as Mason County Eye Clinic

  • Ophthalmologic Surgery Clinic/Center
  • Shelton, WA
National Provider Identifier
1922196609
Registry record updated Jul 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmologic Surgery Clinic/CenterTaxonomy code 261QS0132X
Legal business name
PUBLIC HOSPITAL DISTRICT NO 1 OF MASON COUNTY WASHINGTON
Doing business as
Mason County Eye Clinic
Practice address
2300 Kati CT
Suite C
Shelton, WA 98584-1926
Phone
(360) 426-8717
NPI assigned
Oct 10, 2006
Last updated
Jul 15, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2011

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

Authorized official

Name
Mr. George Robert Appel
Title
Chief Executive Officer
Phone
(360) 427-9556

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X WA
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X WA
Ophthalmologic Surgery Clinic/Center 261QS0132X Primary

Addresses

Primary practice location

2300 Kati CT
Suite C
Shelton, WA 98584-1926

Mailing address

2300 Kati CT
Suite C
Shelton, WA 98584-1900
Phone (360) 426-8717

Other names 1

  • Mason County Eye 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
O20040310001481 WA Part B Supplier - Clinic/Group Practice 0345139275 Receives reassigned benefits from 180 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Shelton, WA; Olympia, WA; Hoodsport, WA
O20050106000705 WA Part A Provider - Critical Access Hospital 0345139275 Receives reassigned benefits from 52 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Shelton, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922196609. Details of each certification follow.

Hospital certification: CCN 501336

Legal name
PUBLIC HOSPITAL DISTRICT NO 1 OF MASON COUNTY
Doing business as
MASON GENERAL HOSPITAL & FAMILY OF CLINICS
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 1, 2005
Last certification
Jan 22, 2016
Beds
25
Ownership / control type
Hospital district or authority
Organization structure
GovernmentNon-profit
Enrollment address
901 Mt View Dr
Shelton, WA 98584-4401
Other Hospital Practice Location

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

Other NPIs on the same Medicare enrollment 13

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

View all 13

Care Compare: Hospital

Medicare Care Compare
Listed as
Mason General Hospital & Family of ClinicsCCN 501336 · All quality measures
Overall star rating
2 of 5
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

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Eric C Moll Individual Corporate Director Jul 1, 2004
W-2 Managing Employee Jul 1, 2004
Stephen Leslie Individual W-2 Managing Employee Dec 31, 2022
Gayle Weston Individual Corporate Officer Nov 1, 2021
Darrin Moody Individual Corporate Officer Nov 1, 2021

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 255

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

View all 255

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310688000000",
    "number": "1922196609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 KATI CT",
            "address_2": "SUITE C",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985841900",
            "telephone_number": "360-426-8717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 KATI CT",
            "address_2": "SUITE C",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985841926",
            "telephone_number": "360-426-8717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HOSPITAL DISTRICT NO 1 OF MASON COUNTY WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2011-07-15",
        "status": "A",
        "authorized_official_last_name": "APPEL",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "360-427-9556",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "WA",
            "license": null,
            "primary": false
        },
        {
            "code": "261QS0132X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ophthalmologic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mason County Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shelton, WA

Sources for this page

Verify at the official NPI Registry.