NPIMap

Organization Active NPI

Providence Health & Services - Oregon

Doing business as PMG Ashland

  • Multi-Specialty Clinic/Center
  • Ashland, OR
National Provider Identifier
1174969778
Registry record updated Nov 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PROVIDENCE HEALTH & SERVICES - OREGON
Doing business as
PMG Ashland
Providence Medical Group South
Practice address
1661 Highway 99 N
Building a, Suite 100
Ashland, OR 97520-8900
Phone
(541) 732-8300
Fax
(541) 732-8301
NPI assigned
May 22, 2013
Last updated
Nov 19, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2025

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

Authorized official

Name
Donald W Anderson Jr.
Title
Assistant Secretary Enrollment
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

1661 Highway 99 N
Building a, Suite 100
Ashland, OR 97520-8900

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (541) 732-8300

Other identifiers 1

IdentifierTypeStateIssuer
500661228MedicaidOR

Other names 2

  • PMG Ashland Doing business as
  • PROVIDENCE MEDICAL GROUP SOUTH Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040310000315 OR Part B Supplier - Clinic/Group Practice 5294623245 Receives reassigned benefits from 200 practitioners
25 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Central Point, OR; Medford, OR; Grants Pass, OR; Eagle Point, OR

Other NPIs on the same Medicare enrollment 25

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

View all 25

National Provider Directory

National Provider Directory

Locations

1661 Highway 99 N
Bldg ASTE100
Ashland, OR 97520

1111 Crater Lake Ave
Medford, OR 97504
Phone (541) 732-5250

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1369180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763510400000",
    "number": "1174969778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "541-732-8300",
            "fax_number": "541-732-8301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1661 HIGHWAY 99 N",
            "address_2": "BUILDING A, SUITE 100",
            "city": "ASHLAND",
            "state": "OR",
            "postal_code": "975208900",
            "telephone_number": "541-732-8300",
            "fax_number": "541-732-8301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-22",
        "last_updated": "2025-11-19",
        "certification_date": "2025-11-19",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500661228",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PMG Ashland",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PMG Ashland",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PROVIDENCE MEDICAL GROUP SOUTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ashland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.