NPIMap

Organization Active NPI

Walla Walla General Hospital

Doing business as Adventist Health Medical Group

  • Rural Health Clinic/Center
  • Walla Walla, WA
National Provider Identifier
1992958771
Registry record updated Mar 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WALLA WALLA GENERAL HOSPITAL
Doing business as
Adventist Health Medical Group
Practice address
1111 S 2ND Ave
Walla Walla, WA 99362-4118
Phone
(509) 522-0100
Fax
(509) 527-8010
NPI assigned
Oct 24, 2008
Last updated
Mar 30, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
WALLA WALLA GENERAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 30, 2017

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

Authorized official

Name
Rick D Bockmann
Title
Ceo
Phone
(509) 527-8000

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 363006281 WA
Multi-Specialty Clinic/Center 261QM1300X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1111 S 2ND Ave
Walla Walla, WA 99362-4118

Mailing address

PO Box 1398
Walla Walla, WA 99362-0309
Phone (509) 522-0100

Other names 1

  • Adventist Health Medical Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992958771. Details of each certification follow.

Rural health clinic certification: CCN 503872

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
BLUE MOUNTAIN MEDICAL GROUP
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 7, 2002
Last certification
Nov 6, 2008
Ownership / control type
2B
Facility address
1111 S 2ND Ave
Walla Walla, WA 99362

National Provider Directory

National Provider Directory
Part of
Walla Walla Gen Hosp

Locations

831 NW Council Dr
Ste 145
Gresham, OR 97030
Phone (503) 489-2650

2700 SE Stratus Ave
Unit 406
McMinnville, OR 97128
Phone (503) 435-1200

10123 SE Market St
Fl 5
Portland, OR 97216

10201 SE Main St
Ste 10A
Portland, OR 97216
Phone (503) 255-2186

1350 NE 122nd Ave
Ste 100
Portland, OR 97230
Phone (503) 408-7010

1700 SW 257th Ave
Troutdale, OR 97060
Phone (503) 669-6800

Practitioners & affiliated clinicians

Practitioners 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1224806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490832000000",
    "number": "1992958771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1398",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993620309",
            "telephone_number": "509-522-0100",
            "fax_number": "509-527-8010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 S 2ND AVE",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993624118",
            "telephone_number": "509-522-0100",
            "fax_number": "509-527-8010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLA WALLA GENERAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALLA WALLA GENERAL HOSPITAL",
        "enumeration_date": "2008-10-24",
        "last_updated": "2017-03-30",
        "status": "A",
        "authorized_official_last_name": "BOCKMANN",
        "authorized_official_first_name": "RICK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-527-8000"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WA",
            "license": "363006281",
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adventist Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Walla Walla, WA

Sources for this page

Verify at the official NPI Registry.