NPIMap

Organization Active NPI

Native American Rehabilitation Assoc Inc

Doing business as Nara NW

  • Federally Qualified Health Center (FQHC)
  • Portland, OR
National Provider Identifier
1053691972
Registry record updated Jul 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NATIVE AMERICAN REHABILITATION ASSOC INC
Doing business as
Nara NW
NARA NW-Wellness Center
Practice address
12360 E Burnside St
Portland, OR 97233-1042
Phone
(971) 279-4800
Fax
(971) 279-2051
NPI assigned
Aug 23, 2011
Last updated
Jul 22, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2026

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

Authorized official

Name
Mr. Ray Dunn
Title
Payroll & Workforce Comp. Director
Phone
(971) 288-9121

Specialties & licenses 1

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

Addresses

Primary practice location

12360 E Burnside St
Portland, OR 97233-1042

Mailing address

PO Box 1569
Attention Credentialing
Portland, OR 97207-1569
Phone (503) 224-1044

Other names 3

  • NARA NW Doing business as
  • NARA NW-Wellness Center Doing business as
  • NATIVE AMERICAN REHABILITATION ASSOCIATION OF THE NORTHWEST, INC. Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040310001435 OR Part B Supplier - Clinic/Group Practice 2668361585 Receives reassigned benefits from 40 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portland, OR; Gresham, OR
O20130705000060 OR Part A Provider - Federally Qualified Health Center (FQHC) 2668361585 Practice locations: Portland, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053691972. Details of each certification follow.

Federally qualified health center certification: CCN 381939

Legal name
NATIVE AMERICAN REHABILITATION ASSOC INC
Doing business as
NARA NW-WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 5, 2013
Last certification
Jul 5, 2013
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
May 11, 1970 in OR
Enrollment address
12360 E Burnside St
Portland, OR 97233-1042

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Tax ID family
Nara-NW Indian Health C10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

12750 SE Stark St
Bldg E
Portland, OR 97233
Phone (971) 347-3009

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Norrine Smokey Smith Individual Corporate OfficerVice President/Secretary Jan 1, 2010
Jacqueline Mercer Individual Corporate OfficerChief Executive Officer Feb 28, 1996 5%
Christine Edlund Individual Corporate DirectorDirector Mar 2, 2024
Cheryl Bittle Individual Corporate OfficerPresident Jan 1, 2007
Cheryl Baldoramo Lucas Individual Corporate OfficerMemeber Nov 28, 2023
Doug Barrett Individual Corporate DirectorDirector Apr 1, 2024
Karen Wheeler Individual Corporate OfficerTreasurer Jan 1, 2019
Joan Onnagan Individual W-2 Managing EmployeeChief of Compliance May 13, 2024

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Nara NWPortland, OR, CCN 381921 Federally qualified health center Operational/Managerial Control Jun 20, 1998
Nara NWPortland, OR, CCN 381880 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1990
Nara NW-Gresham YrtcGresham, OR, CCN 931000 Federally qualified health center Operational/Managerial Control
Other		 Oct 2, 2017
Oct 2, 2017

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 5

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": "1314057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784678400000",
    "number": "1053691972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1569",
            "address_2": "ATTENTION CREDENTIALING",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972071569",
            "telephone_number": "503-224-1044",
            "fax_number": "971-260-0355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12360 E BURNSIDE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972331042",
            "telephone_number": "971-279-4800",
            "fax_number": "971-279-2051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATIVE AMERICAN REHABILITATION ASSOC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-23",
        "last_updated": "2026-07-22",
        "certification_date": "2026-07-22",
        "status": "A",
        "authorized_official_last_name": "DUNN",
        "authorized_official_first_name": "RAY",
        "authorized_official_title_or_position": "PAYROLL & WORKFORCE COMP. DIRECTOR",
        "authorized_official_telephone_number": "971-288-9121",
        "authorized_official_name_prefix": "Mr."
    },
    "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": "NARA NW",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NARA NW-Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NARA NW-Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NATIVE AMERICAN REHABILITATION ASSOCIATION OF THE NORTHWEST, INC.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.