NPIMap

Organization Active NPI

Rogue Community Health

  • Federally Qualified Health Center (FQHC)
  • Butte Falls, OR
National Provider Identifier
1093099616
Registry record updated Feb 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ROGUE COMMUNITY HEALTH
Practice address
722 Laurel Street
Butte Falls, OR 97522-0244
Phone
(541) 842-7799
Fax
(541) 842-7798
NPI assigned
Sep 30, 2011
Last updated
Feb 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2024

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

Authorized official

Name
Calisa N Warnke
Title
Cfo
Phone
(541) 842-7642

Specialties & licenses 1

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

Addresses

Primary practice location

722 Laurel Street
Butte Falls, OR 97522-0244

Mailing address

P.O. Box 244
Butte Falls, OR 97522-0244
Phone (541) 842-7799

Other identifiers 1

IdentifierTypeStateIssuer
227698MedicaidOR

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040226000885 OR Part B Supplier - Clinic/Group Practice 1557266236 Receives reassigned benefits from 47 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Medford, OR
O20111207000748 OR Part A Provider - Federally Qualified Health Center (FQHC) 1557266236 Practice locations: Butte Falls, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093099616. Details of each certification follow.

Federally qualified health center certification: CCN 381927

Legal name
ROGUE COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 10, 2012
Last certification
Jan 10, 2012
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jun 20, 1974 in OR
Enrollment address
722 Laurel Ave
Butte Falls, OR 97522

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory

Locations

1221 Disk Dr
Medford, OR 97501

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Nancy S Nordyke Individual Corporate Director Sep 1, 2020
Johnathan Caldwell Individual Corporate Director Jan 1, 2023
Roger K Howe Individual Corporate Director Jan 1, 2023
John F. Mytinger Individual Corporate DirectorTreasurer Jul 1, 2015
Tom D Hazel Individual Corporate Director Apr 25, 2019
Mary Coombs Individual Corporate Director Jan 1, 2021
Nate Sickler Individual Corporate Director Jan 1, 2023
Martha Miller Individual Corporate Director Jan 1, 2023
Doug D McKenzie Individual Corporate DirectorSecretary Feb 27, 2014
Calisa Noorda Warnke Individual Corporate OfficerCfo Jan 2, 2018
Britney Session Individual Corporate DirectorSenior Director of Finance Jun 27, 2016
William North Individual Corporate OfficerCeo Jan 22, 2014
W-2 Managing Employee Jan 22, 2014
Tina Mondale Individual Corporate Director Oct 1, 2020
Jackson Baures Individual Corporate Director Oct 24, 2019

Owners & managing parties with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1317340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707264000000",
    "number": "1093099616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 244",
            "city": "BUTTE FALLS",
            "state": "OR",
            "postal_code": "975220244",
            "telephone_number": "541-842-7799",
            "fax_number": "541-842-7798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "722 LAUREL STREET",
            "city": "BUTTE FALLS",
            "state": "OR",
            "postal_code": "975220244",
            "telephone_number": "541-842-7799",
            "fax_number": "541-842-7798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGUE COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-30",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A",
        "authorized_official_last_name": "WARNKE",
        "authorized_official_first_name": "CALISA",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "541-842-7642"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "227698",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Butte Falls, OR

Sources for this page

Verify at the official NPI Registry.