Origins Functional Wellness, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

ORIGINS FUNCTIONAL WELLNESS, LLC

Practice address

675 N 5TH St
Jacksonville, OR 97530-9659

Phone

(432) 638-5747

NPI assigned

Aug 14, 2018

Organization subpart

No

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

Authorized official

Name

Kathleen Kay Griffin

Title

Contracting

Phone

(541) 890-1602

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Bronwen Kaye Erickson, FNP-C

  • Family Nurse Practitioner
  • Medford, OR
  • NPI 1154686020
  NPD (past)

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

{
    "created_epoch": "1534204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534204800000",
    "number": "1306326913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 PONDEROSA WAY",
            "city": "JACKSONVILLE",
            "state": "OR",
            "postal_code": "975309018",
            "telephone_number": "432-638-5747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 N 5TH ST",
            "city": "JACKSONVILLE",
            "state": "OR",
            "postal_code": "975309659",
            "telephone_number": "432-638-5747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORIGINS FUNCTIONAL WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-14",
        "last_updated": "2018-08-14",
        "status": "A",
        "authorized_official_last_name": "GRIFFIN",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "CONTRACTING",
        "authorized_official_telephone_number": "541-890-1602"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sang Ly Montage, L.AC.
• Movement Mindset Chiropractic LLC
• Julie Ann Mowatt, L.C.S.W.
• Babbette Lemar Murphy, NP
• Pieter Frederick Oosthuizen, LD
• Haley Morgan May Peterson
• Anthony Derral Phillips, RN, BSN
• Gabrielle Pullen, GCFP, LMT
• David Reamer
• Relatyv Mobile Medical LLC

• Family Medicine Physician in Jacksonville, OR
• Providers in Jacksonville, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.