NPIMap

Organization Active NPI

Providence Health & Services Oregon

  • Community Based Hospice Care Agency
  • Portland, OR
National Provider Identifier
1205924313
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
PROVIDENCE HEALTH & SERVICES OREGON
Practice address
6410 NE Halsey St
Suite 300
Portland, OR 97213-4742
Phone
(503) 215-2273
Fax
(503) 215-8274
NPI assigned
Oct 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2025

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

Authorized official

Name
Donald Wayne Anderson Jr.
Title
Assistant Secretary Enrollments
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

6410 NE Halsey St
Suite 300
Portland, OR 97213-4742

Mailing address

4400 NE Halsey Street
Building 1 Suite 129
Portland, OR 97213-1545
Phone (503) 215-2273

Other practice location 1

3601 SW Murray Blvd Ste 130
Beaverton, OR 97005-2354
Phone (503) 291-6622

Other identifiers 1

IdentifierTypeStateIssuer
241350MedicaidOR

Other names 1

  • Providence Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061222000074 OR Part A Provider - Hospice 6305755000 Practice locations: Beaverton, OR; Hood River, OR; Newberg, OR; Portland, OR

Hospice certification: CCN 381500

Legal name
PROVIDENCE HEALTH & SERVICES OREGON
Doing business as
PROVIDENCE HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Apr 1, 1984
Last certification
Dec 14, 2021
Ownership / control type
Other
Organization structure
CorporationNon-profit
Incorporated
Feb 20, 1934 in OR
Enrollment address
6410 NE Halsey St
Ste 300
Portland, OR 97213-4759

Other NPIs with the same Medicare PAC ID 8

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Providence HospiceCCN 381500
Ownership
Other
Certified
Apr 1, 1984
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Wilson Medical Group18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

9936 SE Washington St
Ste E10
Portland, OR 97216

Ownership & related parties

All disclosed owners & managing parties 24

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

NameRoleSinceShare
Diane L Hejna Individual Corporate DirectorBoard Member Jul 1, 2016
Richard S Blair Individual Corporate DirectorBoard Member Jul 1, 2016
Providence Health & Services-Oregon Organization, Renton, WA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2016 100%
Operational/Managerial Control Jul 1, 2016
Marvin O'Quinn Individual Corporate DirectorBoard Member Jan 1, 2024
Juan Carlos Iregui Individual W-2 Managing EmployeeMD; Feb 10, 2026
Mary Beth Kingston Individual Corporate DirectorBoard Member Sep 1, 2022
Linda Buck Individual Corporate DirectorBoard Member Jan 1, 2025
Jennifer L Traeger Individual W-2 Managing EmployeeAd; Jun 20, 2021
Operational/Managerial ControlDirector-Providence Hospice Jun 20, 2021
Providence Health & Services - Washington Organization, Renton, WA Non-profit Operational/Managerial Control Jan 1, 2010 100%
Mary E Lyons Individual Corporate DirectorBoard Member Jul 1, 2016
Nicole Sikes Individual W-2 Managing EmployeeDirector Aug 22, 2022
Phyllis M Hughes Individual Corporate DirectorBoard Member Jan 1, 2014
Rogelio Riojas Individual Corporate DirectorBoard Member Jan 1, 2025
James Martin Individual Corporate OfficerAsst Treasurer Jan 13, 2023
Charles Wallace Sorenson Individual Corporate DirectorBoard Member Jan 1, 2019
Donald Wayne Anderson Individual Corporate OfficerAsst Sec of Enrollment/Dir Reimb Ad Jan 1, 2017
Gregory David Hoffman Individual Corporate OfficerEvp/Cfe Oct 1, 2020
Isiaah D Crawford Individual Corporate DirectorBoard Member Feb 1, 2012
Donna Markham Individual Corporate DirectorBoard Member Jan 1, 2024
Michael W Murphy Individual Corporate DirectorBoard Member Jan 1, 2020
Eric D Sprunk Individual Corporate DirectorBoard Member Jan 1, 2022
Anna R Newsom Individual Corporate OfficerCorporate Secretary May 13, 2022
Darryl Elmouchi Individual Corporate OfficerPresident Apr 1, 2025
Karin Dufault Individual Corporate DirectorBoard Member Jan 1, 2025

Owners & managing parties with NPI records 2

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

Facilities with the same owner 139

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

View all 139

Practitioners & affiliated clinicians

Practitioners 18

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

View all 18

Affiliated clinicians 135

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 135

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1205924313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 NE HALSEY STREET",
            "address_2": "BUILDING 1 SUITE 129",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972131545",
            "telephone_number": "503-215-2273",
            "fax_number": "503-215-8274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6410 NE HALSEY ST",
            "address_2": "SUITE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972134742",
            "telephone_number": "503-215-2273",
            "fax_number": "503-215-8274"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3601 SW Murray Blvd Ste 130",
            "address_purpose": "LOCATION",
            "city": "Beaverton",
            "state": "OR",
            "postal_code": "970052354",
            "country_code": "US",
            "telephone_number": "503-291-6622",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "241350",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.