MOSAIC MEDICAL DENTAL (NPI# 1174066963) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174066963 |
| Entity Type | Organization |
| Organization Name | MOSAIC MEDICAL DENTAL |
| Other Organization Name | MOSAIC MEDICAL PRINEVILLE DENTAL |
| Practice Address |
375 Nw Beaver St Suite 101 Prineville OR 97754-1802 |
| Mailing Address |
600 Sw Columbia St Suite 6210 Bend OR 97702-1099 |
| Practice Telephone | 5414470707 |
| Practice Fax Number | 5413831883 |
| Mailing Telephone | 5413833005 |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2018-02-28 |
| Authorized Official Name | MEGAN HAASE (CEO) |
| Authorized Official Telephone | 5414470707 |
| Is Organization Subpart | Y |
| Parent Organization Name | MOSAIC MEDICAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities | ||
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 182960 | 05 |
| Other Name | Type Code |
|---|---|
| Mosaic Medical Prineville Dental | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942738588 | Mosaic Medical Dental | Clinic/Center | 1250 Sw Veterans Way, Redmond, OR 97756-2585 | 2017-05-26 |
| 1659888279 | Mosaic Medical Dental | Clinic/Center | 2084 Ne Professional Ct, Bend, OR 97701-6077 | 2018-01-04 |
| Street Address |
375 NW BEAVER ST SUITE 101 |
| City | PRINEVILLE |
| State | OR |
| Zip Code | 97754-1802 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073523122 | Linda Hatch | Nurse Practitioner | 375 Nw Beaver St, Prineville, OR 97754-1802 | 2006-08-09 |
| 1285146928 | Susan Puddy | Registered Nurse | 375 Nw Beaver St, Prineville, OR 97754-1802 | 2017-11-03 |
| 1346785318 | Wendy Perrin | Registered Nurse | 375 Nw Beaver St, Prineville, OR 97754-1802 | 2016-12-30 |
| 1699129890 | Megann Dastrup | Dietitian, Registered | 375 Nw Beaver St, Suite 101, Prineville, OR 97754-1802 | 2016-04-14 |
| 1124482070 | Jennifer Damore | Nurse Practitioner | 375 Nw Beaver St, Suite 100, Prineville, OR 97754-1802 | 2016-04-07 |
| 1548644867 | Katrina Simpson | Registered Nurse | 375 Nw Beaver St, Prineville, OR 97754-1802 | 2015-07-16 |
| 1821489873 | Leah Flegel | Registered Nurse | 375 Nw Beaver St, #100, Prineville, OR 97754-1802 | 2015-02-12 |
| 1114359643 | Rebecca G. Lundgren | Registered Nurse | 375 Nw Beaver St, Suite 101, Prineville, OR 97754-1802 | 2013-08-07 |
| 1992047666 | Paula Yvonne | Registered Nurse | 375 Nw Beaver St, Suite 100, Prineville, OR 97754-1802 | 2013-03-20 |
| 1679811954 | Mosaic Medical | Clinic/Center | 375 Nw Beaver St, Suite 101, Prineville, OR 97754-1802 | 2013-01-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598246290 | Phyllis Louise Young | Physical Therapy Assistant | 350 Ne Brennan Ln, Prineville, OR 97754 | 2018-08-22 |
| 1316424518 | Monte Bainbridge | Counselor | 1103 Ne Elm St Ste B, Prineville, OR 97754 | 2018-07-20 |
| 1841739760 | Gregory Wayne Sanders | Marriage & Family Therapist | 445 Nw 3rd Street, Prineville, OR 97754 | 2017-02-13 |
| 1114474962 | Amy R Duryea | Counselor | 1103 Ne Elm St., Prineville, OR 97754 | 2016-09-08 |
| 1669855052 | Rebecca L Griffith | Mechanotherapist | 298 N Holly St, Prineville, OR 97754 | 2015-07-02 |
| 1376810838 | Jessica Lynn Neely | Counselor | 1333 Nw 9th Street, Prineville, OR 97754 | 2011-11-28 |
| 1205076130 | Dean Arthur Laney | Registered Nurse | 375 Nw Beaver St., Suite 100, Prineville, OR 97754 | 2009-03-05 |
| 1699910513 | Ross E Weakley | Acupuncturist | 298 Sw Harwood, Prineville, OR 97754 | 2008-12-05 |
| 1326208752 | Laura Danielle Gratton | Family Medicine | 975 Nw Beaver Street, Prineville, OR 97754 | 2008-06-10 |
| 1811174550 | Central Oregon Eyecare, PC | Optometrist | 198 Ne Combs Flat Rd, Ste 120, Prineville, OR 97754 | 2008-01-24 |
| Find all providers in zip 97754 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205174653 | Mosaic Medical | Clinic/Center | 757 Ne 1st Street, Prineville, OR 97754-2003 | 2013-01-18 |
| 1629627203 | Mosaic Medical | Clinic/Center | 375 Nw Beaver St Ste 101, Prineville, OR 97754-1802 | 2019-09-06 |
| 1679811954 | Mosaic Medical | Clinic/Center | 375 Nw Beaver St, Suite 101, Prineville, OR 97754-1802 | 2013-01-22 |
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|---|---|---|---|---|
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| 1427563733 | Central City Concern Inc | Clinic/Center | 1415 Se 122nd Ave, Portland, OR 97233 | 2017-12-08 |
| 1598284242 | Winding Waters Medical Clinic | Clinic/Center | 401b N Main St, Joseph, OR 97846-5030 | 2017-09-13 |
| 1750807111 | La Clinica Del Valle Family Health Care Center Inc. | Clinic/Center | 821 N Riverside Ave, Medford, OR 97501 | 2017-08-17 |
| 1477005619 | Outside In | Clinic/Center | 1226 Sw 12th Ave, Portland, OR 97205-2029 | 2016-11-03 |
| Find all providers with the same taxonomy | ||||
| City | PRINEVILLE |
| Zip Code | 97754 |
Please comment or provide details below to improve the information on MOSAIC MEDICAL DENTAL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.