River Rock Family Practice PC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

200550153NP Issued in OR

Legal business name

RIVER ROCK FAMILY PRACTICE PC

Practice address

1833 Nebraska Ave
Grants Pass, OR 97527-5701

Phone

(541) 621-4736

NPI assigned

Oct 29, 2013

Organization subpart

No

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

Authorized official

Name

Tammy Harrison

Title

Secretary

Phone

(541) 226-9840

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• River Rock Family Practice PC

  • Family Nurse Practitioner
  • Medford, OR
  • NPI 1053957225

  O20140228000203

  Same enrollment

Locations

Interoperability endpoints

• Direct secure messaging: mason.harrison.riverrockfamilypractice@jhie.net

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• River Rock Family Practice PC

  • Family Nurse Practitioner
  • Medford, OR
  • NPI 1053957225
  NPPES parent name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeffrey James Cole, FNP

  • Family Nurse Practitioner
  • Medford, OR
  • NPI 1982472601
  Medicare reassignment NPD
• Mason Clarke Harrison, F.N.P.

  • Family Nurse Practitioner
  • Medford, OR
  • NPI 1356355846
  Medicare reassignment NPD

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

{
    "created_epoch": "1383004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1184052136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1833 NEBRASKA AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975275701",
            "telephone_number": "541-226-9840",
            "fax_number": "541-226-9846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1833 NEBRASKA AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975275701",
            "telephone_number": "541-621-4736"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3156 State St",
            "address_purpose": "LOCATION",
            "city": "Medford",
            "state": "OR",
            "postal_code": "975048450",
            "country_code": "US",
            "telephone_number": "541-226-9840",
            "fax_number": "541-226-9846",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RIVER ROCK FAMILY PRACTICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-29",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "541-226-9840"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "200550153NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FNPC",
            "identifier": "200550153NP",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMAP",
            "identifier": "026845",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI INDIVIDUAL",
            "identifier": "1356355846",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole Riley
• Carrie Lynn Risdon
• Peter P Rist, MD
• Emily Kathryn Risty, D.C.
• River City Denture and Dental
• Steve Rivera
• Riverside Home Health Care, Inc
• Madeline Lee Roach
• Cody Roark
• Beverly Robb

• Family Nurse Practitioner in Grants Pass, OR
• Providers in Grants Pass, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.