NPIMap

Organization Active NPI

Hermiston Medical Center P C

  • Rural Health Clinic/Center
  • Hermiston, OR
National Provider Identifier
1255149175
Registry record updated Jan 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HERMISTON MEDICAL CENTER P C
Practice address
600 NW 11TH St Ste E15
Hermiston, OR 97838-8602
Phone
(541) 567-6434
NPI assigned
Dec 23, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2025

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

Authorized official

Name
Derek Ted Earl, MD
Title
Medical Director
Phone
(541) 567-6434

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

600 NW 11TH St Ste E15
Hermiston, OR 97838-8602

Mailing address

600 NW 11TH St Ste E15
Hermiston, OR 97838-8602
Phone (541) 567-6434

Other names 1

  • Family Health Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250519002661 OR Part A Provider - Rural Health Clinic 9133028798 Practice locations: Hermiston, OR

Rural health clinic certification: CCN 383884

Legal name
HERMISTON MEDICAL CENTER P C
Doing business as
FAMILY HEALTH ASSOCIATES
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 4, 2013
Last certification
Mar 3, 2020
Ownership / control type
1B
Most recent change of ownership
Jan 1, 2025 (1 total)
Organization structure
CorporationProprietary
Enrollment address
600 NW 11TH St
Ste E15
Hermiston, OR 97838-8602

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Hermiston Medical Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

10 NE 5th Ave
Milton Frwtr, OR 97862
Phone (541) 567-6434

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Patrick Bernard Johansing Individual Corporate DirectorDirector Dec 31, 2024
Jonas L Oltman Individual Corporate DirectorSecretary Dec 31, 2024
Derek T. Earl Individual Corporate DirectorPresident Dec 31, 2024
Joleen Horning Individual W-2 Managing EmployeeAd; Dec 31, 2024

Owners & managing parties with NPI records 3

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

Change-of-ownership history 1

DateEventCounterparty
Jan 1, 2025 Change of OwnershipThis provider was the buyer Family Health AssociatesCCN 383884, OR, NPI 1114261930

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 8

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": "1734912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736380800000",
    "number": "1255149175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 NW 11TH ST STE E15",
            "city": "HERMISTON",
            "state": "OR",
            "postal_code": "978388602",
            "telephone_number": "541-567-6434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 NW 11TH ST STE E15",
            "city": "HERMISTON",
            "state": "OR",
            "postal_code": "978388602",
            "telephone_number": "541-567-6434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERMISTON MEDICAL CENTER P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-23",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A",
        "authorized_official_last_name": "EARL",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "TED",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "541-567-6434",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Health Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Health Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hermiston, OR

Sources for this page

Verify at the official NPI Registry.