Providence Health & Services - Oregon
Organization Active NPI Clinic/Center · Medford, OR
NPI 1093976243 · NPPES record last updated May 29, 2025
Key facts
- NPI
- 1093976243
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- PROVIDENCE HEALTH & SERVICES - OREGON
- Practice address
- 1111 Crater Lake Ave
Medford, OR 97504-6241 - Phone
- (541) 732-5250
- Fax
- (541) 732-5251
- NPI assigned
- Jun 20, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- PROVIDENCE HEALTH & SERVICES - OREGON
Authorized official
- Name
- Donald W Anderson Jr.
- Title
- Assistant Secretary of Enrollments
- Phone
- (425) 358-9786
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 2
Practitioners 354
-
Emilia Arden, D.O.
-
David Migrandasa Arnopole, FNP-C
-
Puneet Bandi, M.D.
-
Alicia G Bond, MD
-
Brian Timothy Bonner, D.O.
-
Leigh Anne Gustafson, AGACNP-BC
-
Brandan A Hull, MD
-
Richard Lloyd Julyan, M.D.
-
Aaron J Kramer, MD
-
David Levin, DO
-
Raquel P Moore, PA-C
-
Nikhila Palle, MD
-
Pratibha Seshadri, M.D
-
Rajpreet Singh, M.D.
-
Christel A. Steffen, D.O.
-
Jerry Noel Centeno, M.D.
-
Neha Garg, MD
-
Kamika Gower-Allum, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Part of
- Providence Hospital Lab
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | OR | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500617088 | Medicaid | OR |
Other names
- Providence Medford Medical Center
- Providence Palliative Care South
Other providers in Medford, OR
- Phoebe Ann Pritchett
- Kaye Proctor
- Justice Prosis
- Providence Health & Services - Oregon
- Providence Health & Services - Oregon
- Providence Health & Services - Oregon
- Providence Health & Services - Oregon
- Providence Health & Services - Oregon
- Providence Health & Services - Oregon
- Providence Health & Services - Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.