NPIMap

Organization Active NPI

Praxis Health, PC

  • Rural Health Clinic/Center
  • La Grande, OR
National Provider Identifier
1336749621
Registry record updated Aug 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PRAXIS HEALTH, PC
Practice address
2011 Fourth St.
La Grande, OR 97850
Phone
(541) 963-4139
Fax
(541) 429-6612
NPI assigned
Oct 27, 2020
Last updated
Aug 30, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
PRAXIS HEALTH, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 30, 2021

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

Authorized official

Name
Jessica M Reagan
Title
Revenue Cycle Director
Phone
(541) 966-6136

Specialties & licenses 1

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

Addresses

Primary practice location

2011 Fourth St.
La Grande, OR 97850

Mailing address

PO Box 1517
Pendleton, OR 97801-0410
Phone (877) 708-1119

Other names 1

  • Praxis Medical Group, INC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210105001260 OR Part A Provider - Rural Health Clinic 8325941446 Practice locations: La Grande, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336749621. Details of each certification follow.

Rural health clinic certification: CCN 383904

Legal name
PRAXIS HEALTH PC
Doing business as
LA GRANDE FAMILY MEDICINE
Organization structure
CorporationProprietary
Incorporated
Nov 5, 1996 in OR
Enrollment address
2011 4TH St
La Grande, OR 97850-2511

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Praxis Medical Group in7 organizations share this tax ID, including this one
Part of
Praxis Medical Group in

Other organizations with this tax ID 6

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

Member of 1

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

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Garrett Kennedy Individual Corporate OfficerCeo Jan 1, 2016
Corporate DirectorSecretary/Director Jan 1, 1996
W-2 Managing EmployeeCeo Jan 1, 2016
Interpath Laboratory Inc Organization, Pendleton, OR Corporation 5% Or Greater Indirect Ownership Interest Apr 11, 2011 100%
Stephen a Mann Individual Corporate DirectorPresident/Director Jan 1, 1996
Adaugeo Healthcare Solutions LLC Organization, Pendleton, OR LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Dec 1, 2007 99%
Operational/Managerial Control Dec 1, 2007
Jessica Morgan Individual Corporate DirectorBoard Member/Director Jan 1, 1996

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 3

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

NPI Registry JSON

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

{
    "created_epoch": "1603756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630281600000",
    "number": "1336749621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1517",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978010410",
            "telephone_number": "877-708-1119",
            "fax_number": "541-278-8349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2011 FOURTH ST.",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "97850",
            "telephone_number": "541-963-4139",
            "fax_number": "541-429-6612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAXIS HEALTH, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRAXIS HEALTH, PC",
        "enumeration_date": "2020-10-27",
        "last_updated": "2021-08-30",
        "certification_date": "2021-08-30",
        "status": "A",
        "authorized_official_last_name": "REAGAN",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "541-966-6136"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Praxis Medical Group, INC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in La Grande, OR

Sources for this page

Verify at the official NPI Registry.