Northwest Medical Foundation of Tillamook
Organization Active NPI Rural Health Clinic/Center · Manzanita, OR
NPI 1154699379 · NPPES record last updated Sep 8, 2025
Key facts
- NPI
- 1154699379
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK
- Practice address
- 10445 Neah-Kah-Nie CR Rd
Manzanita, OR 97130 - Phone
- (503) 842-4444
- NPI assigned
- Dec 2, 2011
- Organization subpart
- Yes
- Parent organization (as reported)
- NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK
Authorized official
- Name
- Micah Smith
- Title
- Fo
- Phone
- (503) 815-2263
Owners & managing parties with NPI records 1
-
Kenneth Jutzy, M.D.
Other NPIs on the same Medicare enrollment 12
Other NPIs with the same Medicare PAC ID 7
Related certifications (CCN) 4
Facilities with the same owner 105
Practitioners 94
-
Brittany Gerken, M.D.
-
William Goodhue, MD
-
Benius Karl Meier Jr., M.D.
-
Michael Lee Beadnell, M.D.
-
Michelle T Ashley, NP-BC
-
Kamaljit K Atwal, DO
-
James Borden, MD
-
Ronald Chelsky, M.D.
-
Ann Marie Cooley, MD
-
Jessi Marie Cox, M.D.
-
Francisco Cruz III, M.D.
-
Onome Edokun, APRN, AG/ACNP-BC
-
Ruben Franco Garcia, P.A.-C
-
Gerald E Gibbs, M.D.
-
James R Gilmore, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OR
Rural health clinic certification: CCN 388510
- Legal name
- NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK
- Doing business as
- ADVENTIST HEALTH TILLAMOOK MEDICAL GROUP MANZANITA PRIMARY & SPECIALTY
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jul 16, 2012
- Last certification
- Jul 24, 2019
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 15, 1973 in OR
- Enrollment address
- 10445 Neahkahnie Creek Rd
Manzanita, OR 97130-0129 - Related CCNs
- 381317
All disclosed owners & managing parties 20
| Name | Role | Since | Share |
|---|---|---|---|
| Micah P Smith |
Corporate Officer |
Oct 1, 2017 | |
| W-2 Managing Employee |
Jul 1, 2017 | ||
| Kerry L Heinrich |
Corporate Officer |
Jan 1, 2022 | |
| Corporate Director | Dec 15, 2014 | ||
| Regina F Seufert |
Corporate Officer |
Jul 1, 2017 | |
| W-2 Managing Employee |
Jul 1, 2017 | ||
| John H Cress |
Corporate Director |
Oct 1, 2024 | |
| Meredith S Jobe |
Corporate Officer |
Mar 31, 2014 | |
| Eric a Stevens |
Corporate Officer |
Mar 5, 2025 | |
| Richard K Reiner |
Corporate Director |
Jan 16, 2017 | |
| Joy a. Fehr |
Corporate Director |
Oct 1, 2020 | |
| Jonathan J Daggett |
Corporate Director |
Jan 1, 2024 | |
| Andrew R Davis |
Corporate Director |
May 5, 2017 | |
| Ann K Beckett |
Corporate Director |
Jan 1, 2024 | |
| Marc K Woodson |
Corporate Director |
Jan 1, 2019 | |
| John C Freedman |
Corporate Director |
Sep 26, 2016 | |
| Jack W Wagner |
Corporate Director |
Dec 1, 2022 | |
| Eric Swanson |
Corporate Officer |
Sep 9, 2019 | |
| W-2 Managing Employee | Sep 9, 2019 | ||
| Kenneth Jutzy |
Corporate Director |
Jan 1, 2024 | |
| Bradford C Newton |
Corporate Director |
Aug 16, 2021 | |
| Robert a Cherry |
Corporate Director |
May 5, 2017 | |
| Larry L Innocent |
Corporate Director |
Sep 19, 2011 | |
| Adventist Health System/West |
Operational/Managerial Control | Jun 16, 1980 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031208000676 | OR | Part B Supplier - Clinic/Group Practice | 5092619569 |
Receives reassigned benefits from 218 practitioners 12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Tillamook, OR; Welches, OR; Vernonia, OR; Sheridan, OR; Pacific City, OR; Manzanita, OR; Lincoln City, OR; Estacada, OR |
| O20120222000231 | OR | Part a Provider - Rural Health Clinic | 5092619569 | Practice locations: Manzanita, OR |
National Provider Directory
- Part of
- Tillamook Co General Ho
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes | ||
| Critical Access Hospital | 282NC0060X | 141177 | OR |
Addresses
Primary practice location
10445 Neah-Kah-Nie CR Rd
Manzanita, OR 97130
Mailing address
PO Box 888860
Los Angeles, CA 90088-8860
Phone (503) 815-2116
Other names
- Adventist Health/Tillamook Medical Group Manzanita Primary & Specialty
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Bluemark LLC / Office Ally |
Other providers in Manzanita, OR
- Scott Thomas Galvin
- Judi Hanson
- Longevity
- John Clark Miller
- Deb Montgomery
- Orthopedic Toe Guard
- Pauseful LLC
- Amy Pulitzer
- Holly E Smith
- Weichert Wellness, LLC
All providers in Manzanita, OR · Rural Health Clinic/Center in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.