NPIMap

Organization Active NPI

Columbia Basin Health Association

  • Federally Qualified Health Center (FQHC)
  • Othello, WA
National Provider Identifier
1992923064
Registry record updated May 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
OD00003794 Issued in WA
Legal business name
COLUMBIA BASIN HEALTH ASSOCIATION
Doing business as
Columbia Basin Health Association
Practice address
1515 E Columbia St
Othello, WA 99344-1846
Phone
(509) 488-5256
Fax
(509) 488-9939
NPI assigned
Apr 23, 2007
Last updated
May 6, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2022

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

Authorized official

Name
Nieves Gomez
Title
Ceo
Phone
(509) 488-5256

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X WA
Federally Qualified Health Center (FQHC) 261QF0400X OD00003794 WA Primary

Addresses

Primary practice location

1515 E Columbia St
Othello, WA 99344-1846

Mailing address

1515 E. Columbia St.
Othello, WA 99344
Phone (509) 488-5256

Other names 1

  • Columbia Basin Health Association Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101027000085 WA Part A Provider - Federally Qualified Health Center (FQHC) 4486564309 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Othello, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992923064. Details of each certification follow.

Federally qualified health center certification: CCN 501815

Legal name
COLUMBIA BASIN HEALTH ASSOCIATION
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Mar 26, 1973 in WA
Enrollment address
1515 E Columbia St
Othello, WA 99344-1846

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Columbia Basin Health Assoc17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Joshua Bunch Individual Corporate OfficerVP of Finance Mar 1, 2018
Deborah Buss Individual Corporate OfficerTreasurer Feb 26, 2013
Maria Quezada Individual Corporate DirectorBoard Member Mar 28, 2017
Martha Holt Individual Corporate DirectorBoard Member Apr 19, 2017
Nieves Gomez Individual Corporate DirectorCeo Mar 1, 2018 100%
W-2 Managing EmployeeCeo Mar 1, 2018 100%
Operational/Managerial ControlCeo Mar 1, 2018 100%
Joe Montemayor Individual Corporate DirectorChairman Aug 26, 2010
Dora Beraza Individual Corporate DirectorBoard Member Aug 26, 2010
Enrique Miron Individual Corporate DirectorBoard Member Aug 26, 2010
Marisol Quezada Individual Corporate DirectorBoard Secretary Jan 31, 2023
Mike Garza Individual Corporate DirectorEmeritus Member Aug 26, 2010
Maria Rosales Individual Corporate DirectorBoard Member May 27, 2014
Scott Harris Individual Corporate DirectorVice Chair May 28, 2019
Martin Gallardo Individual Corporate DirectorBoard Member May 25, 2010
Gloria Ochoa Individual Corporate DirectorBoard Member Jan 31, 2023

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651795200000",
    "number": "1992923064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 E. COLUMBIA ST.",
            "city": "OTHELLO",
            "state": "WA",
            "postal_code": "99344",
            "telephone_number": "509-488-5256",
            "fax_number": "509-488-9939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 E COLUMBIA ST",
            "city": "OTHELLO",
            "state": "WA",
            "postal_code": "993441846",
            "telephone_number": "509-488-5256",
            "fax_number": "509-488-9939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA BASIN HEALTH ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2022-05-06",
        "certification_date": "2022-05-06",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "NIEVES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-488-5256"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WA",
            "license": "OD00003794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Columbia Basin Health Association",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Othello, WA

Sources for this page

Verify at the official NPI Registry.