NPIMap

Organization Active NPI

County of Tillamook

  • Federally Qualified Health Center (FQHC)
  • Rockaway Beach, OR
National Provider Identifier
1184887523
Registry record updated Nov 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
MD11776 Issued in OR
Legal business name
COUNTY OF TILLAMOOK
Doing business as
Tillamook County Health Department
Tillamook County Health Department - Rockaway Beach Clinic
Practice address
276 S Highway 101
Rockaway Beach, OR 97136-1015
Phone
(503) 355-2700
Fax
(503) 355-2702
NPI assigned
Jul 7, 2008
Organization subpart
Yes
Parent organization
COUNTY OF TILLAMOOKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 13, 2020

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

Authorized official

Name
Ms. Marlene L Putman, JD
Title
Administrator
Phone
(503) 842-3900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X MD11776 OR Primary

Addresses

Primary practice location

276 S Highway 101
Rockaway Beach, OR 97136-1015

Mailing address

801 Pacific Ave
Tillamook, OR 97141-3926
Phone (503) 842-3900

Other identifiers 2

IdentifierTypeStateIssuer
116488OtherORNORIDIAN
128756MedicaidOR

Other names 2

  • Tillamook County Health Department Doing business as
  • Tillamook County Health Department - Rockaway Beach Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040413000702 OR Part B Supplier - Clinic/Group Practice 3173411287 Receives reassigned benefits from 10 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cloverdale, OR; Rockaway Beach, OR; Tillamook, OR
O20100830000339 OR Part A Provider - Federally Qualified Health Center (FQHC) 3173411287 Practice locations: Rockaway Beach, OR

Federally qualified health center certification: CCN 381862

Legal name
COUNTY OF TILLAMOOK
Doing business as
TILLAMOOK COUNTY HEALTH DEPARTMENT
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 20, 2004
Last certification
Apr 20, 2004
Ownership / control type
Non-profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
276S Highway 101
Rockaway Beach, OR 97136-1015

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Part of
County of Tillamook

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Debra Clark Individual W-2 Managing EmployeeCounty Treasurer Sep 1, 2011 100%
County of Tillamook Organization, Rockaway Beach, OR Operational/Managerial Control Jul 1, 2001
Marlene L Putman Individual W-2 Managing EmployeeAdministrator Nov 5, 2010 100%

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Tillamook County Health DepartmentTillamook, OR, CCN 381824 Federally qualified health center Operational/Managerial Control Jul 1, 1994
Main Street Health CenterTillamook, OR, CCN 381054 Federally qualified health center General Partnership Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 1994
Jul 1, 1994

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1215388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605225600000",
    "number": "1184887523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 PACIFIC AVE",
            "city": "TILLAMOOK",
            "state": "OR",
            "postal_code": "971413926",
            "telephone_number": "503-842-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "276 S HIGHWAY 101",
            "city": "ROCKAWAY BEACH",
            "state": "OR",
            "postal_code": "971361015",
            "telephone_number": "503-355-2700",
            "fax_number": "503-355-2702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF TILLAMOOK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF TILLAMOOK",
        "enumeration_date": "2008-07-07",
        "last_updated": "2020-11-13",
        "certification_date": "2020-11-13",
        "status": "A",
        "authorized_official_last_name": "PUTMAN",
        "authorized_official_first_name": "MARLENE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "503-842-3900",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "OR",
            "license": "MD11776",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORIDIAN",
            "identifier": "116488",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "128756",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tillamook County Health Department",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tillamook County Health Department - Rockaway Beach Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rockaway Beach, OR

Sources for this page

Verify at the official NPI Registry.