NPIMap

Organization Active NPI

Shriners Hospitals for Children

  • Clinic/Center
  • Medford, OR
National Provider Identifier
1295407815
Registry record updated Oct 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
SHRINERS HOSPITALS FOR CHILDREN
Practice address
750 Murphy Rd
Medford, OR 97504-8426
Phone
(503) 396-9148
Fax
(503) 221-3701
NPI assigned
Oct 1, 2021
Organization subpart
Yes
Parent organization
SHRINERS HOSPITALS FOR CHILDRENAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 1, 2021

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

Authorized official

Name
Mr. Jerry G. Gantt
Title
President
Phone
(813) 281-0300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

750 Murphy Rd
Medford, OR 97504-8426

Mailing address

PO Box 8500 Lockbox 7642
Philadelphia, PA 19178-7642
Phone (813) 281-0300

Other names 1

  • Shriners Children's Medford Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130924000520 OR Part B Supplier - Clinic/Group Practice 9133031933 Receives reassigned benefits from 20 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Medford, OR; Redmond, OR; Portland, OR

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
Tax ID family
Shriners Hospitals for Children - Philadelphia49 organizations share this tax ID, including this one
Part of
Shriners Hospitals for Children - Philadelphia

Other organizations with this tax ID 48

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

View all 48

Locations

215 Radio Dr
Woodbury, MN 55125
Phone (612) 596-6100

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1633046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633046400000",
    "number": "1295407815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8500 LOCKBOX 7642",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191787642",
            "telephone_number": "813-281-0300",
            "fax_number": "813-281-0943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 MURPHY RD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048426",
            "telephone_number": "503-396-9148",
            "fax_number": "503-221-3701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHRINERS HOSPITALS FOR CHILDREN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHRINERS HOSPITALS FOR CHILDREN",
        "enumeration_date": "2021-10-01",
        "last_updated": "2021-10-01",
        "certification_date": "2021-10-01",
        "status": "A",
        "authorized_official_last_name": "GANTT",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-281-0300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shriners Children's Medford Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2021; 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.