Pacificsource Pace, LLC

Primary specialty

PACE Provider OrganizationTaxonomy code 251T00000X

Legal business name

PACIFICSOURCE PACE, LLC

Practice address

555 International Way Ste B104
Springfield, OR 97477-6013

Phone

(458) 544-0400

NPI assigned

Nov 21, 2025

Organization subpart

No

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

Authorized official

Name

Kristin Kernutt, JD

Title

Chief Legal Counsel

Phone

(541) 225-1967

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1763683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784160000000",
    "number": "1104787704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 INTERNATIONAL WAY STE B104",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974776013",
            "telephone_number": "458-544-0400",
            "fax_number": "541-255-2797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 INTERNATIONAL WAY STE B104",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974776013",
            "telephone_number": "458-544-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFICSOURCE PACE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-21",
        "last_updated": "2026-07-16",
        "certification_date": "2026-07-16",
        "status": "A",
        "authorized_official_last_name": "KERNUTT",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "CHIEF LEGAL COUNSEL",
        "authorized_official_telephone_number": "541-225-1967",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• PACE Provider Organization in Springfield, OR
• Providers in Springfield, OR by specialty
• PACE Provider Organization in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.