NPIMap

Organization Active NPI

Northwest Medical Foundation of Tillamook

Doing business as Adventist Health/Tillamook Medical Group Manzanita Primary & Specialty

  • Rural Health Clinic/Center
  • Manzanita, OR
National Provider Identifier
1154699379
Registry record updated Sep 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK
Doing business as
Adventist Health/Tillamook Medical Group Manzanita Primary & Specialty
Practice address
10445 Neah-Kah-Nie CR Rd
Manzanita, OR 97130
Phone
(503) 842-4444
NPI assigned
Dec 2, 2011
Last updated
Sep 8, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHWEST MEDICAL FOUNDATION OF TILLAMOOKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 8, 2025

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

Authorized official

Name
Micah Smith
Title
Fo
Phone
(503) 815-2263

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
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 1

  • Adventist Health/Tillamook Medical Group Manzanita Primary & Specialty Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC / Office Ally

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154699379. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Aug 15, 1973 in OR
Enrollment address
10445 Neahkahnie Creek Rd
Manzanita, OR 97130-0129
Related CCNs
381317

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory
Part of
Tillamook Cty General

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Micah P Smith Individual Corporate OfficerTreasurer Oct 1, 2017
W-2 Managing EmployeeCfo Jul 1, 2017
Kerry L Heinrich Individual Corporate OfficerChair Jan 1, 2022
Corporate Director Dec 15, 2014
Regina F Seufert Individual Corporate OfficerVP/Physician&Clinic Services Jul 1, 2017
W-2 Managing EmployeeVP/Physician&Clinic Services Jul 1, 2017
John H Cress Individual Corporate DirectorBoard Member Oct 1, 2024
Meredith S Jobe Individual Corporate OfficerSecretary Mar 31, 2014
Eric a Stevens Individual Corporate OfficerVice Chair Mar 5, 2025
Richard K Reiner Individual Corporate DirectorBoard Member Jan 16, 2017
Joy a. Fehr Individual Corporate DirectorBoard Member Oct 1, 2020
Jonathan J Daggett Individual Corporate DirectorBoard Member Jan 1, 2024
Andrew R Davis Individual Corporate DirectorBoard Member May 5, 2017
Ann K Beckett Individual Corporate DirectorBoard Member Jan 1, 2024
Marc K Woodson Individual Corporate DirectorBoard Member Jan 1, 2019
John C Freedman Individual Corporate DirectorBoard Member Sep 26, 2016
Jack W Wagner Individual Corporate DirectorBoard Member Dec 1, 2022
Eric Swanson Individual Corporate OfficerPresident Sep 9, 2019
W-2 Managing Employee Sep 9, 2019
Kenneth Jutzy Individual Corporate DirectorBoard Member Jan 1, 2024
Bradford C Newton Individual Corporate DirectorBoard Member Aug 16, 2021
Robert a Cherry Individual Corporate DirectorBoard Member May 5, 2017
Larry L Innocent Individual Corporate DirectorBoard Member Sep 19, 2011
Adventist Health System/West Organization, Roseville, CA Non-profit Operational/Managerial Control Jun 16, 1980 100%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 105

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 105

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1322784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757289600000",
    "number": "1154699379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 888860",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900888860",
            "telephone_number": "503-815-2116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10445 NEAH-KAH-NIE CR RD",
            "city": "MANZANITA",
            "state": "OR",
            "postal_code": "97130",
            "telephone_number": "503-842-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK",
        "enumeration_date": "2011-12-02",
        "last_updated": "2025-09-08",
        "certification_date": "2025-09-08",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "MICAH",
        "authorized_official_title_or_position": "FO",
        "authorized_official_telephone_number": "503-815-2263"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "OR",
            "license": "141177",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10445 Neah-Kah-Nie Cr Rd",
            "city": "Manzanita",
            "state": "OR",
            "country_code": "US",
            "postal_code": "97130",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Adventist Health/Tillamook Medical Group Manzanita Primary & Specialty",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Adventist Health/Tillamook Medical Group Manzanita Primary & Specialty",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manzanita, OR

Sources for this page

Verify at the official NPI Registry.