NPIMap

Organization Active NPI

Bandon Community Health Center

  • Primary Care Clinic/Center
  • Bandon, OR
National Provider Identifier
1033348289
Registry record updated Oct 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
23131 Issued in OR
Legal business name
BANDON COMMUNITY HEALTH CENTER
Practice address
1010 1St St SE
Bandon, OR 97411-9301
Phone
(541) 347-2529
Fax
(541) 347-9196
NPI assigned
Jul 9, 2009
Last updated
Oct 3, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2014

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

Authorized official

Name
Ms. Linda S Maxon
Title
Executive Director
Phone
(541) 347-2529

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 23131 OR Primary

Addresses

Primary practice location

1010 1St St SE
Bandon, OR 97411-9301

Mailing address

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

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
Practice locations: Bandon, OR; Port Orford, OR
O20140423001435 OR Part A Provider - Federally Qualified Health Center (FQHC) 1557416757 Practice locations: Bandon, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033348289. Details of each certification follow.

Federally qualified health center certification: CCN 381943

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
Apr 25, 2014
Last certification
Apr 25, 2014
Ownership / control type
Non-profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 13, 2009 in OR
Enrollment address
1010 1St St SE
Ste 110
Bandon, OR 97411-9301

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

Locations

1010 1st St SE
Ste 110
Bandon, OR 97411

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Nicole Dougherty Individual W-2 Managing EmployeeHuman Resource Generalist Feb 7, 2022
Kendra Newbold Individual 5% Or Greater Indirect Ownership InterestChief Executive Officer Feb 16, 2024 100%
Corporate OfficerChief Executive Officer Feb 16, 2024
W-2 Managing EmployeeAd; Feb 16, 2024
Maryjane Labelle Individual Corporate Director Oct 26, 2022
Mari Lochhaas Individual Corporate Director Feb 23, 2022
Leslie Devine Individual Corporate OfficerChief Compliance Officer Sep 21, 2021
W-2 Managing EmployeeAd; Sep 21, 2021
Joseph McLeod Individual Corporate Director Jul 16, 2017
Sally Glunt Individual Corporate DirectorChair, Board of Directors Aug 1, 2015
Michael Torres Individual Corporate OfficerChief Medical Officer Nov 8, 2023
W-2 Managing EmployeeAd;MD; Nov 8, 2023
Colene Hickman Individual Corporate Officer Oct 18, 2023
W-2 Managing EmployeeDirector of Finance Oct 18, 2024
Ginger Swan Individual Corporate Director Mar 29, 2023
Steven Borror Individual Corporate Director Jan 30, 2019
Joe Wegner Individual Corporate DirectorBoard Finance Commitee Chair Oct 26, 2022
Clark Kocurek Individual Corporate Director Sep 28, 2022
Joseph Caspary Individual Corporate Director Jan 27, 2021
Anne Goddard Individual Corporate DirectorBoard Chair Feb 23, 2022
Elizabeth Wood Individual Corporate DirectorSecretary, Board of Directors Jul 1, 2015

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1247097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412294400000",
    "number": "1033348289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 1ST ST SE",
            "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": "1010 1ST ST SE",
            "city": "BANDON",
            "state": "OR",
            "postal_code": "974119301",
            "telephone_number": "541-347-2529",
            "fax_number": "541-347-9196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANDON COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-09",
        "last_updated": "2014-10-03",
        "status": "A",
        "authorized_official_last_name": "MAXON",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "541-347-2529",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "OR",
            "license": "23131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bandon, OR

Sources for this page

Verify at the official NPI Registry.