NPIMap

Organization Active NPI

Whidbey Island Public Hospital District

  • Rural Health Clinic/Center
  • Oak Harbor, WA
National Provider Identifier
1982116901
Registry record updated Jul 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT
Practice address
275 SE Cabot Dr Ste B101
Oak Harbor, WA 98277-3740
Phone
(360) 675-6648
Fax
(360) 679-2487
NPI assigned
Oct 31, 2017
Organization subpart
Yes
Parent organization
WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 20, 2023

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

Authorized official

Name
Garth Miller
Title
Coo
Phone
(360) 678-7656

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

275 SE Cabot Dr Ste B101
Oak Harbor, WA 98277-3740

Mailing address

275 SE Cabot Dr Ste B101
Oak Harbor, WA 98277-3740
Phone (360) 675-6648

Other names 1

  • WhidbeyHealth Primary Care - Cabot Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171129003305 WA Part A Provider - Rural Health Clinic 1658280680 Practice locations: Oak Harbor, WA

Rural health clinic certification: CCN 508584

Legal name
WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT
Doing business as
WHIDBEYHEALTH PRIMARY CARE - CABOT
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 21, 2018
Last certification
Dec 21, 2018
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
275 SE Cabot Dr
Ste B101
Oak Harbor, WA 98277-3740
Related CCNs
501339

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

Other NPIs with the same Medicare PAC ID 12

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

National Provider Directory

National Provider Directory
Tax ID family
North Whidbey Comm Clin38 organizations share this tax ID, including this one
Part of
North Whidbey Comm Clin

Other organizations with this tax ID 37

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

View all 37

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Whidbey Island Public Hospital District Organization, Coupeville, WA Other Apr 1, 2011
Curtis Andrew Shumate Individual Corporate OfficerExecutive Director of Nursing Feb 1, 2022
Corporate DirectorExecutive Director of Nursing Feb 1, 2022
W-2 Managing Employee Feb 22, 2010
Kirk P Gasper Individual Corporate OfficerCommissioner Dec 2, 2025
Corporate DirectorCommissioner Dec 2, 2025
Garth a Miller Individual Corporate OfficerChief Operations Officer Sep 23, 2021
Corporate DirectorChief Operations Officer Sep 23, 2021
W-2 Managing Employee Aug 1, 2018
James Dean Golder Individual Corporate DirectorCommissioner Jan 1, 2022
Simi Kohli Individual Corporate DirectorMedical Director Jul 11, 2024
Mark Ethan Borden Individual Corporate OfficerCommissioner Jan 1, 2026
Corporate DirectorCommissioner Jan 1, 2026
Marion Louise Jouas Individual Corporate DirectorCommissioner Dec 14, 2023
Jamie Canby Individual Corporate OfficerCommissioner Jan 1, 2026
Corporate DirectorCommissioner Jan 1, 2026
Paul Rogers Individual Corporate OfficerCfo Sep 16, 2022
Corporate Director Sep 16, 2022
Nathan Staggs Individual Corporate Officer Mar 22, 2023
Corporate DirectorCeo Mar 22, 2023

Owners & managing parties with NPI records 13

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

View all 13

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
Whidbeyhealth Medical CenterCoupeville, WA, CCN 501339 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Whidbeyhealth Medical CenterCoupeville, WA, CCN 50Z339 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 1966
Whidbeyhealth Hospice CareCoupeville, WA, CCN 501542 Hospice 5% Or Greater Direct Ownership Interest (100%) Jan 30, 2013
Whidbeyhealth Primary Care - Goldie St.Oak Harbor, WA, CCN 503996 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 1, 1962
Jan 1, 1962
Whidbeyhealth Primary Care - ClintonClinton, WA, CCN 508506 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 1, 1962
Jan 1, 1962
Whidbeyhealth Primary Care - FreelandFreeland, WA, CCN 508585 Rural health clinic Other (100%) Apr 1, 1969
Whidbeyhealth Primary Care - CoupevilleCoupeville, WA, CCN 508583 Rural health clinic Other (100%) Apr 1, 1969

Owned or controlled facilities with NPI records 12

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

Practitioners & affiliated clinicians

Practitioners 104

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

View all 104

NPI Registry JSON

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

{
    "created_epoch": "1509408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689811200000",
    "number": "1982116901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 SE CABOT DR STE B101",
            "city": "OAK HARBOR",
            "state": "WA",
            "postal_code": "982773740",
            "telephone_number": "360-675-6648",
            "fax_number": "360-679-2487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 SE CABOT DR STE B101",
            "city": "OAK HARBOR",
            "state": "WA",
            "postal_code": "982773740",
            "telephone_number": "360-675-6648",
            "fax_number": "360-679-2487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT",
        "enumeration_date": "2017-10-31",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-20",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "GARTH",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "360-678-7656"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WhidbeyHealth Primary Care - Cabot",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Oak Harbor, WA

Sources for this page

Verify at the official NPI Registry.