NPIMap

Organization Active NPI

Coos County Oregon

  • Public Health or Welfare Agency
  • Coos Bay, OR
National Provider Identifier
1063576908
Registry record updated May 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
License
092007202N7 Issued in OR
Legal business name
COOS COUNTY OREGON
Practice address
281 Laclair Street
Coos Bay, OR 97420
Phone
(541) 266-6700
NPI assigned
Dec 21, 2006
Last updated
May 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2025

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

Authorized official

Name
Dawn Broughton
Title
Accounting Supervisor
Phone
(541) 266-6716

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X 092007202N7 OR Primary
Ambulatory Family Planning Facility 261QA0005X OR
Case Manager/Care Coordinator 171M00000X OR

Addresses

Primary practice location

281 Laclair Street
Coos Bay, OR 97420

Mailing address

281 Laclair Street
Coos Bay, OR 97420
Phone (541) 266-6700

Other identifiers 4

IdentifierTypeStateIssuer
320077MedicaidOR
R0000PHCLTOtherORMASS IMMUNIZATION ROSTER BILLING
045174MedicaidOR
097386MedicaidOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040809000185 OR Part B Supplier - Mass Immunization (Roster Biller Only) 1759353071 Practice locations: Coos Bay, OR

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Coos County Oregon5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

1975 McPherson St
Ste 1
North Bend, OR 97459
Phone (541) 751-2400

Practitioners & affiliated clinicians

Practitioners 9

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": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747785600000",
    "number": "1063576908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "281 LACLAIR STREET",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "97420",
            "telephone_number": "541-266-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "281 LACLAIR STREET",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "97420",
            "telephone_number": "541-266-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOS COUNTY OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "status": "A",
        "authorized_official_last_name": "BROUGHTON",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "ACCOUNTING SUPERVISOR",
        "authorized_official_telephone_number": "541-266-6716"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "OR",
            "license": "092007202N7",
            "primary": true
        },
        {
            "code": "261QA0005X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Family Planning Facility",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "OR",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "320077",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MASS IMMUNIZATION ROSTER BILLING",
            "identifier": "R0000PHCLT",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "045174",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "097386",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coos Bay, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2025; 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.