NPIMap

Organization Active NPI

Northwest Medical Foundation of Tillamook

Doing business as Adventist Health Tillamook Medical Group - Banks

  • Rural Health Clinic/Center
  • Banks, OR
National Provider Identifier
1043740616
Registry record updated Jan 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK
Doing business as
Adventist Health Tillamook Medical Group - Banks
Practice address
12350 NW Main St Ste 112
Banks, OR 97106-9045
Phone
(503) 842-4444
Fax
(503) 815-2330
NPI assigned
Jun 15, 2017
Last updated
Jan 14, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHWEST MEDICAL FOUNDATION OF TILLAMOOKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 14, 2022

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

Authorized official

Name
Micah Smith
Title
Fo
Phone
(503) 815-2263

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Critical Access Hospital 282NC0060X 141177 OR

Addresses

Primary practice location

12350 NW Main St Ste 112
Banks, OR 97106-9045

Mailing address

PO Box 888860
Los Angeles, CA 90088-8860

Other names 1

  • Adventist Health Tillamook Medical Group - Banks Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031208000676 OR Part B Supplier - Clinic/Group Practice 5092619569 Receives reassigned benefits from 218 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tillamook, OR; Welches, OR; Vernonia, OR; Sheridan, OR; Pacific City, OR; Manzanita, OR; Lincoln City, OR; Estacada, OR

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory
Part of
Tillamook Cty General

Locations

1105 SE Jetty Ave
Ste C
Lincoln City, OR 97367
Phone (541) 265-4947

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1497484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642118400000",
    "number": "1043740616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 888860",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900888860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12350 NW MAIN ST STE 112",
            "city": "BANKS",
            "state": "OR",
            "postal_code": "971069045",
            "telephone_number": "503-842-4444",
            "fax_number": "503-815-2330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK",
        "enumeration_date": "2017-06-15",
        "last_updated": "2022-01-14",
        "certification_date": "2022-01-14",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "MICAH",
        "authorized_official_title_or_position": "FO",
        "authorized_official_telephone_number": "503-815-2263"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "OR",
            "license": "141177",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adventist Health Tillamook Medical Group - Banks",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Banks, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.