NPIMap

Organization Active NPI

Confederated Tribes of the Grand Ronde Community of Oregon

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Grand Ronde, OR
National Provider Identifier
1174666358
Registry record updated Feb 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
Legal business name
CONFEDERATED TRIBES OF THE GRAND RONDE COMMUNITY OF OREGON
Practice address
9605 Grand Ronde Rd
Grand Ronde, OR 97347-9712
Phone
(503) 879-2236
Fax
(503) 879-5089
NPI assigned
Feb 15, 2007
Last updated
Feb 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2024

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

Authorized official

Name
Kelly D Rowe
Title
Executive Director Health Services
Phone
(503) 879-2075

Specialties & licenses 14

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Community Health Clinic/Center 261QC1500X
Federally Qualified Health Center (FQHC) 261QF0400X 126883 OR
Radiology Clinic/Center 261QR0200X 445142 OR
Clinical Medical Laboratory 291U00000X 38D0862855 OR
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X Primary
Pharmacy 333600000X 1559 OR
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X

Addresses

Primary practice location

9605 Grand Ronde Rd
Grand Ronde, OR 97347-9712

Mailing address

PO Box 338
Grand Ronde, OR 97347-0338
Phone (503) 879-2236

Other practice location 1

1011 Commercial St NE Ste 110
Salem, OR 97301-1036
Phone (503) 983-9900

Other practice location 2

3580 SE 82nd Ave
Portland, OR 97266-2902
Phone (971) 339-9240

Other identifiers 1

IdentifierTypeStateIssuer
500786332MedicaidOR

Other names 2

  • Grand Ronde Health and Wellness Center Other name
  • Great Circle Recovery Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040320000494 OR Part B Supplier - Clinic/Group Practice 6103717277 Receives reassigned benefits from 25 practitioners
Practice locations: Grand Ronde, OR; Portland, OR; Salem, OR; Sheridan, OR

Other NPIs with the same Medicare PAC ID 1

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D0862855Grand Ronde Health & Wellness Center Lab9605 Grand Ronde Rd, Grand Ronde, OR 97347ComplianceDec 18, 2027

National Provider Directory

National Provider Directory
Tax ID family
Confederated Tribes of Grand Ronde Community of Oregon Dba GR Health6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 56

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 56

NPI Registry JSON

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709078400000",
    "number": "1174666358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 338",
            "city": "GRAND RONDE",
            "state": "OR",
            "postal_code": "973470338",
            "telephone_number": "503-879-2236",
            "fax_number": "503-879-5089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9605 GRAND RONDE RD",
            "city": "GRAND RONDE",
            "state": "OR",
            "postal_code": "973479712",
            "telephone_number": "503-879-2236",
            "fax_number": "503-879-5089"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1011 Commercial St NE Ste 110",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973011036",
            "country_code": "US",
            "telephone_number": "503-983-9900",
            "fax_number": "503-983-9899",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3580 SE 82nd Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972662902",
            "country_code": "US",
            "telephone_number": "971-339-9240",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CONFEDERATED TRIBES OF THE GRAND RONDE COMMUNITY OF OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2024-02-28",
        "certification_date": "2024-02-28",
        "status": "A",
        "authorized_official_last_name": "ROWE",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR HEALTH SERVICES",
        "authorized_official_telephone_number": "503-879-2075"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "OR",
            "license": "126883",
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "OR",
            "license": "445142",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "OR",
            "license": "38D0862855",
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "OR",
            "license": "1559",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500786332",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Ronde Health and Wellness Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Great Circle Recovery",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Grand Ronde, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.