NPIMap

Organization Active NPI

Bandon Community Health Ctr

Doing business as Coast Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Port Orford, OR
National Provider Identifier
1013587484
Registry record updated Jun 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BANDON COMMUNITY HEALTH CTR
Doing business as
Coast Community Health Center
Practice address
312 Tichenor St
Port Orford, OR 97465-8672
Phone
(541) 347-2529
Fax
(541) 347-9196
NPI assigned
Jun 29, 2021
Last updated
Jun 29, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
BANDON COMMUNITY HEALTH CTRAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 29, 2021

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

Authorized official

Name
Linda S Maxon
Title
Ceo
Phone
(541) 347-2529

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

312 Tichenor St
Port Orford, OR 97465-8672

Mailing address

1010 1St St SE Ste 110
Bandon, OR 97411-9301
Phone (541) 347-2529

Other names 1

  • Coast Community Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100430000431 OR Part B Supplier - Clinic/Group Practice 1557416757 Receives reassigned benefits from 22 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bandon, OR; Port Orford, OR
O20220805002034 OR Part A Provider - Federally Qualified Health Center (FQHC) 1557416757 Practice locations: Port Orford, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013587484. Details of each certification follow.

Federally qualified health center certification: CCN 381009

Legal name
BANDON COMMUNITY HEALTH CENTER
Certification status
Terminated Voluntary: merger or closure, Sep 30, 2025
Provider type (POS)
Federally qualified health center
Participating since
Aug 3, 2022
Last certification
Aug 3, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 13, 2009 in OR
Enrollment address
1312 Tichenor St
Port Orford, OR 97465-8776

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Part of
Bandon Community Health Center

Locations

1010 1st St SE
Ste 110
Bandon, OR 97411

780 2nd St SE
Ste 7
Bandon, OR 97411
Phone (540) 347-2529

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Mari Lochhaas Individual Corporate DirectorBoard Member Jan 13, 2022
Bryan Thompson Individual Corporate DirectorBoard Member Feb 4, 2022
Greg Fodrea Individual Corporate DirectorBoard Member Jun 25, 2021
Joseph McLeod Individual Corporate DirectorBoard President Jul 26, 2017
Linda S Maxon Individual Corporate OfficerCeo Jan 3, 2010 100%
W-2 Managing EmployeeCeo Jan 3, 2010 100%
David Gerhart Individual Corporate DirectorBoard Treasurer Mar 1, 2019
Steven Borror Individual Corporate DirectorBoard Member Mar 1, 2019
Nicole C Heitzman Individual W-2 Managing EmployeeAccounting Manager Dec 31, 2020 100%
Operational/Managerial ControlAccounting Manager Dec 31, 2020 100%
Anne Goddard Individual Corporate DirectorBoard Member Feb 15, 2022

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1624924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624924800000",
    "number": "1013587484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 1ST ST SE STE 110",
            "city": "BANDON",
            "state": "OR",
            "postal_code": "974119301",
            "telephone_number": "541-347-2529",
            "fax_number": "541-347-9196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 TICHENOR ST",
            "city": "PORT ORFORD",
            "state": "OR",
            "postal_code": "974658672",
            "telephone_number": "541-347-2529",
            "fax_number": "541-347-9196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANDON COMMUNITY HEALTH CTR",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BANDON COMMUNITY HEALTH CTR",
        "enumeration_date": "2021-06-29",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-08",
        "status": "A",
        "authorized_official_last_name": "MAXON",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-347-2529"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coast Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Orford, OR

Sources for this page

Verify at the official NPI Registry.