NPIMap

Organization Active NPI

Good Shepherd Health Care System

Doing business as Good Shepherd Medical Group

  • Pediatrics Physician
  • Hermiston, OR
National Provider Identifier
1336198159
Registry record updated Oct 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
GOOD SHEPHERD HEALTH CARE SYSTEM
Doing business as
Good Shepherd Medical Group
Practice address
600 NW 11TH St Ste E33
Hermiston, OR 97838-8604
Phone
(541) 667-3740
Fax
(541) 667-3732
NPI assigned
May 9, 2006
Last updated
Oct 22, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
GOOD SHEPHERD HEALTH CARE SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 22, 2026

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

Authorized official

Name
Jonathan Edwards
Title
Coo/Cfo
Phone
(541) 667-3412

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X
Pediatrics Physician 208000000X Primary
Pediatric Gastroenterology Physician 2080P0206X

Addresses

Primary practice location

600 NW 11TH St Ste E33
Hermiston, OR 97838-8604

Mailing address

600 NW 11TH St Ste E37
Hermiston, OR 97838-8604
Phone (541) 667-3486

Other names 1

  • GOOD SHEPHERD MEDICAL GROUP Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031118000046 OR Part B Supplier - Clinic/Group Practice 9133033764 Receives reassigned benefits from 349 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hermiston, OR
O20050705000457 OR Part A Provider - Rural Health Clinic 9133033764 Practice locations: Hermiston, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336198159. Details of each certification follow.

Rural health clinic certification: CCN 383985

Legal name
GOOD SHEPHERD HEALTH CARE SYSTEM
Doing business as
GOOD SHEPHERD MEDICAL GROUP RHC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 16, 2000
Last certification
Jul 18, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
May 8, 1953 in OR
Enrollment address
600 NW 11TH St
Ste E37
Hermiston, OR 97838-8604
Related CCNs
381325

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Good Shepherd Medical G

Locations

600 NW 11th St
Ste E21
Hermiston, OR 97838
Phone (541) 567-2270

600 NW 11th St
Ste E23
Hermiston, OR 97838
Phone (509) 942-3272

610 NW 11th St
#E37
Hermiston, OR 97838

620 NW 11th St
#M202
Hermiston, OR 97838

620 NW 11th St
Ste M106
Hermiston, OR 97838
Phone (541) 667-3801

620 NW 11th St
Ste M201
Hermiston, OR 97838

620 NW 11th St
Ste M202
Hermiston, OR 97838
Phone (541) 667-3804

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Jaclyn Jenkins Individual Corporate DirectorBoard Member Oct 23, 2023
Robert Longoria Individual Corporate DirectorBoard Member Oct 23, 2023
Carl Carlson Individual Corporate Director Sep 23, 2002
Arthur Mathisen Individual Corporate OfficerPresident/Ceo Jul 24, 2023 100%
Brian Patrick Individual Corporate OfficerVP of Nursing Sep 8, 2020
Susan Daggett Individual Corporate Director Nov 6, 2006
Arnell Eynon Individual Corporate Director Apr 23, 2013
Jon Lorence Individual Corporate DirectorBoard Member Oct 22, 2018
Nancy Mabry Individual Corporate Director Nov 6, 2006
Jonathan Edwards Individual Corporate OfficerCoo/Cfo Apr 7, 2008
W-2 Managing EmployeeCoo/Cfo Apr 7, 2008
Lisa Mittelsdorf Individual Corporate DirectorBoard Member Oct 28, 2019
Merle Steven Eldrige Individual Corporate Director Sep 11, 2003
Derek T. Earl Individual Corporate Director Sep 24, 2007
Kristen Coller Individual Corporate DirectorBoard Member Oct 24, 2022
Jeff Wenholz Individual Corporate DirectorBoard Member Oct 28, 2019

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 141

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.

View all 141

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792627200000",
    "number": "1336198159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 NW 11TH ST STE E37",
            "city": "HERMISTON",
            "state": "OR",
            "postal_code": "978388604",
            "telephone_number": "541-667-3486",
            "fax_number": "541-667-3487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 NW 11TH ST STE E33",
            "city": "HERMISTON",
            "state": "OR",
            "postal_code": "978388604",
            "telephone_number": "541-667-3740",
            "fax_number": "541-667-3732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD HEALTH CARE SYSTEM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GOOD SHEPHERD HEALTH CARE SYSTEM",
        "enumeration_date": "2006-05-09",
        "last_updated": "2026-10-22",
        "certification_date": "2026-10-22",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "COO/CFO",
        "authorized_official_telephone_number": "541-667-3412"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GOOD SHEPHERD MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GOOD SHEPHERD MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hermiston, OR

Sources for this page

Verify at the official NPI Registry.