NPIMap

Organization Active NPI

Mosaic Medical Dental

Doing business as Mosaic Medical Prineville Dental

  • Federally Qualified Health Center (FQHC)
  • Prineville, OR
National Provider Identifier
1174066963
Registry record updated Feb 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MOSAIC MEDICAL DENTAL
Doing business as
Mosaic Medical Prineville Dental
Practice address
375 NW Beaver St
Suite 101
Prineville, OR 97754-1802
Phone
(541) 447-0707
Fax
(541) 383-1883
NPI assigned
Nov 28, 2016
Organization subpart
Yes
Parent organization
MOSAIC MEDICALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 28, 2018

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

Authorized official

Name
Megan Haase
Title
Ceo
Phone
(541) 447-0707

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

375 NW Beaver St
Suite 101
Prineville, OR 97754-1802

Mailing address

600 SW Columbia St
Suite 6210
Bend, OR 97702-1099
Phone (541) 383-3005

Other identifiers 1

IdentifierTypeStateIssuer
182960MedicaidOR

Other names 1

  • Mosaic Medical Prineville Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mosaic Medical28 organizations share this tax ID, including this one
Part of
Mosaic Medical

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1480291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519776000000",
    "number": "1174066963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 SW COLUMBIA ST",
            "address_2": "SUITE 6210",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021099",
            "telephone_number": "541-383-3005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 NW BEAVER ST",
            "address_2": "SUITE 101",
            "city": "PRINEVILLE",
            "state": "OR",
            "postal_code": "977541802",
            "telephone_number": "541-447-0707",
            "fax_number": "541-383-1883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSAIC MEDICAL DENTAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOSAIC MEDICAL",
        "enumeration_date": "2016-11-28",
        "last_updated": "2018-02-28",
        "status": "A",
        "authorized_official_last_name": "HAASE",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-447-0707"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182960",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mosaic Medical Prineville Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prineville, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.