Peace of Mind Functional Medicine

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

PEACE OF MIND FUNCTIONAL MEDICINE

Practice address

151 SW Shevlin Hixon Dr Ste 201
Bend, OR 97702-3233

Phone

(458) 202-9231

Fax

(541) 797-6113

NPI assigned

Mar 18, 2020

Organization subpart

No

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

Authorized official

Name

Mary Kate Coppedge, PMHNP

Title

Owner

Phone

(541) 222-9231

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1584489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584489600000",
    "number": "1083240386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 SW SHEVLIN HIXON DR STE 201",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023233",
            "telephone_number": "458-202-9231",
            "fax_number": "541-797-6113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 SW SHEVLIN HIXON DR STE 201",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023233",
            "telephone_number": "458-202-9231",
            "fax_number": "541-797-6113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACE OF MIND FUNCTIONAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-18",
        "last_updated": "2020-03-18",
        "certification_date": "2020-03-18",
        "status": "A",
        "authorized_official_last_name": "COPPEDGE",
        "authorized_official_first_name": "MARY KATE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-222-9231",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194057661",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kcoppedge@peaceofmindfm.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "151 SW Shevlin Hixon Dr Ste 201",
            "city": "Bend",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977023233",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Janell Payne, ND
• Shelby Payne
• Payson Flattery ND DC PC
• Rena Leon Pazienza, PHD
• Anette Gail Santos Pe, FNP-C
• Peak Medical Transit LLC
• Peak Medical Transit LLC
• Peak Wellness Services
• Rachel Pearce, LAC
• Valerie Karen Pearce, LMT

• Adolescent and Children Mental Health Clinic/Center in Bend, OR
• Providers in Bend, OR by specialty
• Adolescent and Children Mental Health Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.