PROVIDENCE HEALTH & SERVICES OREGON (NPI# 1386713972) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386713972 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES OREGON |
| Other Organization Name | PMG SOUTH MEDFORD FAMILY PRACTICE |
| Practice Address |
1698 E Mcandrews Rd Suite 300 Medford OR 97504-5589 |
| Mailing Address |
Po Box 3158 Portland OR 97208-3158 |
| Practice Telephone | 5417327950 |
| Practice Fax Number | 5417327901 |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2019-04-24 |
| Authorized Official Name | DONALD WAYNE ANDERSON JR. (ASST CORP SECRETARY FOR ENROLLMENTS) |
| Authorized Official Telephone | 4255255392 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 288499 | 05 | |
| OR | RAILROAD MEDICARE | CG6801 | 01 |
| Other Name | Type Code |
|---|---|
| PMG SOUTH MEDFORD FAMILY PRACTICE | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518425693 | Providence Health & Services Oregon | Durable Medical Equipment & Medical Supplies | 2296 Nw Kings Blvd Ste 101, Corvallis, OR 97330-3871 | 2019-03-07 |
| 1841756764 | Providence Health & Services Oregon | Family Medicine | 171 N Larch St Ste 16, Cannon Beach, OR 97110-3103 | 2019-02-15 |
| 1346751443 | Providence Health & Services Oregon | General Practice | 4400 Ne Halsey St, Pop 2, 3rd Floor, Portland, OR 97213-1545 | 2017-10-16 |
| 1922453943 | Providence Health & Services Oregon | Assisted Living Facility | 1550 Brookside Dr, Hood River, OR 97031-8553 | 2016-04-27 |
| 1649541020 | Providence Health & Services Oregon | Clinic/Center | 211 Ne Skyline Dr, White Salmon, WA 98672 | 2012-01-18 |
| 1922330828 | Providence Health & Services Oregon | Pharmacy | 18040 Sw Lower Boones Ferry Rd Ste 104, Tigard, OR 97224-7259 | 2010-02-03 |
| 1801010004 | Providence Health & Services Oregon | Internal Medicine | 4805 Ne Glisan St Ste 11n, Portland, OR 97213-2933 | 2007-04-12 |
| 1487746491 | Providence Health & Services Oregon | Home Health | 2033 Commerce Dr, Medford, OR 97504-9744 | 2006-09-28 |
| 1831196302 | Providence Health & Services Oregon | Home Health | 570 S Main Street, Mount Angel, OR 97362-9540 | 2005-06-30 |
| 1003319724 | Providence Health & Services Oregon | Clinic/Center | 5211 Ne Glisan St Bldg C, Portland, OR 97213-3052 | 2018-03-09 |
| Street Address |
1698 E MCANDREWS RD SUITE 300 |
| City | MEDFORD |
| State | OR |
| Zip Code | 97504-5589 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407844525 | Deidre Goldberg | Nurse Practitioner | 1698 E Mcandrews Rd, Ste 300, Medford, OR 97504-5589 | 2005-10-12 |
| 1063963106 | Providence Health & Services - Oregon | Clinic/Center | 1698 E Mcandrews Rd, Ste 300, Medford, OR 97504-5589 | 2016-10-24 |
| 1992254080 | Yadira Amaral | Community Health Worker | 1698 E Mcandrews Rd, Ste 170, Medford, OR 97504-5589 | 2016-09-29 |
| 1841674173 | Judy Wong | Pharmacist | 1698 E Mcandrews Rd, Suite 400, Medford, OR 97504-5589 | 2015-07-16 |
| 1669870432 | Ashley Auspelmyer | Physician Assistant | 1698 E Mcandrews Rd, Providence Plaza, Suite 280, Medford, OR 97504-5589 | 2014-12-10 |
| 1801292107 | Sara G Hoppe | Physician Assistant | 1698 E Mcandrews Rd, Ste 160, Medford, OR 97504-5589 | 2014-11-13 |
| 1669609954 | Susan Bernier Martin | Registered Nurse | 1698 E Mcandrews Rd, Suite 170, Medford, OR 97504-5589 | 2009-06-15 |
| 1457517849 | Vivian Nkem Chidi | Internal Medicine | 1698 E Mcandrews Rd, Ste 170, Medford, OR 97504-5589 | 2008-08-05 |
| 1659530442 | Kadi-ann Bryan | Urology | 1698 E Mcandrews Rd, Suite 280, Medford, OR 97504-5589 | 2008-06-05 |
| 1679761944 | Skin Cncr & Ent Center | Specialist | 1698 E Mcandrews Rd, Suite 220, Medford, OR 97504-5589 | 2007-10-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
| 1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
| 1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
| 1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
| 1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
| 1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
| 1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
| 1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
| 1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
| 1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
| Find all providers in zip 97504 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346847332 | Jasmine Barnhart | Family Medicine | 1935 Canyon Ave, Medford, OR 97504-2128 | 2020-10-03 |
| 1831742667 | Mallory Marie Morton | Family Medicine | 429 Main St # 3, Medford, MA 02155-6571 | 2019-07-21 |
| 1841619418 | Andrew Thomas Gomez | Family Medicine | 131 Rte 70 W, Ste 100, Medford, NJ 08055 | 2014-04-10 |
| 1992140313 | Stephanie Guido | Family Medicine | 128 Route 70 Ste Aandb, Medford, NJ 08055-2371 | 2013-04-30 |
| 1316214281 | Carl Russell Griesser | Family Medicine | 555 Black Oak Drive, Suite 100, Medford Medical Clinic, Medford, OR 97504 | 2011-11-21 |
| 1649591223 | Wesley T Ramoso | Family Medicine | 3225 Hillcrest Park Dr, Medford, OR 97504-7657 | 2010-06-17 |
| 1891945812 | Amy Holmes Medical Services Plc | Family Medicine | 102 E Cherokee, Medford, OK 73759-1210 | 2008-09-26 |
| 1972793370 | Sowmya Reddy Thadisina | Family Medicine | 101 Main St Ste 214, Medford, MA 02155-4530 | 2007-07-31 |
| 1689890667 | James K Robinson II | Family Medicine | W5238 Jolly Ave, Medford, WI 54451-9303 | 2007-04-18 |
| 1316160658 | Island Medical of Medford, LLP | Family Medicine | 1647 Route 112, Medford, NY 11763-3635 | 2007-04-11 |
| Find all providers in MEDFORD | ||||
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| 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.