NPIMap

Organization Active NPI

Good Shepherd Health Care System

Doing business as Vange John Memorial Hospice

  • Community Based Hospice Care Agency
  • Hermiston, OR
National Provider Identifier
1346295029
Registry record updated Aug 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
GOOD SHEPHERD HEALTH CARE SYSTEM
Doing business as
Vange John Memorial Hospice
Practice address
610 NW 11TH St
Hermiston, OR 97838
Phone
(541) 667-3400
Fax
(541) 667-3454
NPI assigned
May 23, 2006
Last updated
Aug 16, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2013

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

Authorized official

Name
Dennis E Burke
Title
President and Ceo
Phone
(541) 667-3400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X OR Primary

Addresses

Primary practice location

610 NW 11TH St
Hermiston, OR 97838

Mailing address

610 NW 11TH St
Hermiston, OR 97838
Phone (541) 667-3400

Other identifiers 5

IdentifierTypeStateIssuer
7260409OtherWAWASHINGTON DSHS
298808MedicaidOR
B80023OtherORBLUE CROSS
11096OtherWAWASHINGTON L&I
3001302OtherWAWASHINGTON DSHS

Other names 1

  • Vange John Memorial Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050705000473 OR Part A Provider - Hospice 9133033764 Practice locations: Hermiston, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346295029. Details of each certification follow.

Hospice certification: CCN 381543

Legal name
GOOD SHEPHERD HEALTH CARE SYSTEM
Doing business as
VANGE JOHN MEMORIAL HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Nov 13, 1998
Last certification
Aug 2, 2022
Ownership / control type
Non-Profit - Private
Organization structure
CorporationNon-profit
Incorporated
May 8, 1953 in OR
Enrollment address
645 W Orchard Ave Ste 300
Hermiston, OR 97838-1671

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Vange John Memorial HospiceCCN 381543 · All quality measures
Ownership
Non-Profit
Certified
Nov 13, 1998
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
TLC Home Health Medic7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 10

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 DirectorBoard Member Jul 13, 2013
Arthur Mathisen Individual Corporate OfficerPresident/Ceo Jul 24, 2023 100%
Susan Daggett Individual Corporate DirectorBoard Member Jul 13, 2013
Nancy Mabry Individual Corporate DirectorBoard Member Jul 13, 2013
Jonathan Edwards Individual Corporate OfficerCoo/Cfo Nov 1, 2023
W-2 Managing EmployeeCoo/Cfo Jul 13, 2013
Merle Steven Eldrige Individual Corporate DirectorBoard Member Jul 13, 2013
Derek T. Earl Individual Corporate DirectorBoard Member Jul 13, 2013
Kristen Coller Individual Corporate DirectorBoard Member Oct 24, 2022

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

Affiliated clinicians 12

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376611200000",
    "number": "1346295029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 NW 11TH ST",
            "city": "HERMISTON",
            "state": "OR",
            "postal_code": "97838",
            "telephone_number": "541-667-3400",
            "fax_number": "541-667-3454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 NW 11TH ST",
            "city": "HERMISTON",
            "state": "OR",
            "postal_code": "97838",
            "telephone_number": "541-667-3400",
            "fax_number": "541-667-3454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD HEALTH CARE SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2013-08-16",
        "status": "A",
        "authorized_official_last_name": "BURKE",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "541-667-3400"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON DSHS",
            "identifier": "7260409",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "298808",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "B80023",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON L&I",
            "identifier": "11096",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON DSHS",
            "identifier": "3001302",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vange John Memorial Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hermiston, OR

Sources for this page

Verify at the official NPI Registry.