NPIMap

Organization Active NPI

Providence St Joseph Medical Center

  • Critical Access Hospital
  • Polson, MT
National Provider Identifier
1992853881
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
12513 Issued in MT
Legal business name
PROVIDENCE ST JOSEPH MEDICAL CENTER
Practice address
6 13TH Ave E
Polson, MT 59860-5315
Phone
(406) 883-5377
Fax
(406) 883-8488
NPI assigned
Jan 8, 2007
Organization subpart
Yes
Parent organization
PROVIDENCE HEALTH & SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 7, 2025

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

Authorized official

Name
Donald W Anderson Jr.
Title
Assistant Secretary Enrollment
Phone
(425) 358-9786

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X
Critical Access Hospital 282NC0060X 12513 MT Primary

Addresses

Primary practice location

6 13TH Ave E
Polson, MT 59860-5315

Mailing address

PO Box 31001-4110
Pasadena, CA 91110-4110

Other identifiers 1

IdentifierTypeStateIssuer
27Z343OtherMTPTAN

Other names 2

  • Prov St Joseph Med Ctr SWB Doing business as
  • Providence St Joseph Medical Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071001000198 MT Part A Provider - Critical Access Hospital 0446230247 Practice locations: Polson, MT

Hospital certification: CCN 27Z343

Legal name
PROVIDENCE ST JOSEPH MEDICAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Feb 1, 1991 in MT
Enrollment address
6 13TH Ave E
Polson, MT 59860-5315
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
St Joseph Orthopedic and Sport7 organizations share this tax ID, including this one
Part of
Providence Service Corporation

Other organizations with this tax ID 6

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 24

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

NameRoleSinceShare
Diane L Hejna Individual Corporate DirectorBoard Member Jul 1, 2016
Richard S Blair Individual Corporate DirectorBoard Member Jul 1, 2016
Marvin O'Quinn Individual Corporate DirectorBoard Member Jan 1, 2024
Linda Buck Individual Corporate DirectorBoard Member Mar 4, 1969
Providence Health & Services - Washington Organization, Renton, WA Non-profit Operational/Managerial Control Jan 1, 2006
Mary E Lyons Individual Corporate DirectorBoard Member Jul 1, 2016
Kirk Francis Bodlovic Individual W-2 Managing EmployeeCfe Jan 1, 2013
Phyllis M Hughes Individual Corporate DirectorBoard Member Jan 1, 2014
Rogelio Riojas Individual Corporate DirectorBoard Member Jan 1, 2025
James Martin Individual Corporate OfficerAssistant Treasurer Jan 13, 2023
Charles Wallace Sorenson Individual Corporate DirectorBoard Member Jan 1, 2019
Donald Wayne Anderson Individual Corporate OfficerAsst Sec Enrollmt/Dir Reimb Reg Jan 1, 2017
Gregory David Hoffman Individual Corporate OfficerPresident/Ceo & Treasurer Oct 1, 2020
Providence Health & Services Mt Organization, Renton, WA Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2010 100%
Operational/Managerial Control Jan 1, 2010
Isiaah D Crawford Individual Corporate DirectorBoard Member Feb 1, 2012
Donna Markham Individual Corporate DirectorBoard Member Jan 1, 2024
Michael W Murphy Individual Corporate DirectorBoard Member Jan 1, 2020
Providence Health & Services Organization, Renton, WA Non-profit Other Dec 31, 2009
Mary Beth Kingston Individual Corporate Director Sep 1, 2022
Eric D Sprunk Individual Corporate Director Jan 1, 2022
Anna R Newsom Individual Corporate Director May 13, 2022
Darryl Elmouchi Individual Corporate OfficerPresident/Ce Apr 1, 2025
Karin Dufault Individual Corporate DirectorBoard Member Jan 1, 2025
Providence St. Joseph Health Organization, Renton, WA Non-profit Operational/Managerial Control Jul 1, 2016

Owners & managing parties with NPI records 6

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

Facilities with the same owner 143

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

View all 143

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746576000000",
    "number": "1992853881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-4110",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 13TH AVE E",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "598605315",
            "telephone_number": "406-883-5377",
            "fax_number": "406-883-8488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE ST JOSEPH MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HEALTH & SERVICES",
        "enumeration_date": "2007-01-08",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MT",
            "license": "12513",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "27Z343",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prov St Joseph Med Ctr SWB",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence St Joseph Medical Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Polson, MT

Sources for this page

Verify at the official NPI Registry.