Rogue Community Health

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

ROGUE COMMUNITY HEALTH

Practice address

11160 Highway 62 Ste a
Eagle Point, OR 97524-8025

Phone

(541) 842-7704

NPI assigned

Nov 25, 2020

Last updated

Nov 25, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Calisa Warnke

Title

Cfo

Phone

(541) 842-7642

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184228504. Details of each certification follow.

• CCN 381001 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 381001

Legal name

ROGUE COMMUNITY HEALTH

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Sep 22, 2021

Last certification

Sep 22, 2021

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Nov 24, 2020 in OR

Enrollment address

11160 Highway 62
Eagle Point, OR 97524-8025

Other NPIs on the same Medicare enrollment 1

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

• Rogue Community Health

  • Federally Qualified Health Center (FQHC)
  • Eagle Point, OR
  • NPI 1790059731

  O20210812000877

  Same enrollment

Locations

All disclosed owners & managing parties 15

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

Owners & managing parties with NPI records 1

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

• Tom David Hazel, FNP

  • Family Nurse Practitioner
  • Talent, OR
  • NPI 1316944754

  Corporate Director

  CMS ownership

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

{
    "created_epoch": "1606262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606262400000",
    "number": "1184228504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 E MAIN ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975047667",
            "telephone_number": "541-930-5611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11160 HIGHWAY 62 STE A",
            "city": "EAGLE POINT",
            "state": "OR",
            "postal_code": "975248025",
            "telephone_number": "541-842-7704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGUE COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-25",
        "last_updated": "2020-11-25",
        "certification_date": "2020-11-24",
        "status": "A",
        "authorized_official_last_name": "WARNKE",
        "authorized_official_first_name": "CALISA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "541-842-7642"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "227698",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kasandra K Prill, LMT
• Providence Health & Services - Oregon (PMG Eagle Point Pediatrics)
• Providence Health & Services - Oregon (PMG South Eagle Point)
• Robert L Nutting
• Wendy Robinson
• Rogue Community Health
• Rogue Community Health
• Judy Alethe Rudy, LCSW
• Amanda Salas
• Jennifer D Schnell, LMT#20190

• Federally Qualified Health Center (FQHC) in Eagle Point, OR
• Providers in Eagle Point, OR by specialty
• Federally Qualified Health Center (FQHC) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.