NPIMap

Organization Active NPI

Providence Health & Services - Oregon

Doing business as Providence Medford Medical Center

  • Clinic/Center
  • Medford, OR
National Provider Identifier
1093976243
Registry record updated May 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PROVIDENCE HEALTH & SERVICES - OREGON
Doing business as
Providence Medford Medical Center
Providence Palliative Care South
Practice address
1111 Crater Lake Ave
Medford, OR 97504-6241
Phone
(541) 732-5250
Fax
(541) 732-5251
NPI assigned
Jun 20, 2008
Last updated
May 29, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HEALTH & SERVICES - OREGONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 29, 2025

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

Authorized official

Name
Donald W Anderson Jr.
Title
Assistant Secretary of Enrollments
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X OR Primary

Addresses

Primary practice location

1111 Crater Lake Ave
Medford, OR 97504-6241

Mailing address

PO Box 31001-4199
Pasadena, CA 91110-4199
Phone (541) 732-5250

Other names 2

  • Providence Medford Medical Center Doing business as
  • Providence Palliative Care South Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031217000186 OR Part B Supplier - Clinic/Group Practice 3476450560 Receives reassigned benefits from 339 practitioners
2 other NPIs on this enrollment
Practice locations: Medford, OR

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Part of
Providence Hosp Medic

Practitioners & affiliated clinicians

Practitioners 354

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.

View all 354

NPI Registry JSON

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

{
    "created_epoch": "1213920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748476800000",
    "number": "1093976243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-4199",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104199",
            "telephone_number": "541-732-5250",
            "fax_number": "541-732-5251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 CRATER LAKE AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046241",
            "telephone_number": "541-732-5250",
            "fax_number": "541-732-5251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "enumeration_date": "2008-06-20",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Medford Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Palliative Care South",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 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.