NPIMap

Organization Active NPI

Central City Concern, Inc.

  • Federally Qualified Health Center (FQHC)
  • Portland, OR
National Provider Identifier
1366010647
Registry record updated Apr 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTRAL CITY CONCERN, INC.
Practice address
11450 SE Division St
Portland, OR 97266-1150
Phone
(503) 294-1681
NPI assigned
Jun 14, 2021
Last updated
Apr 9, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2026

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

Authorized official

Name
Dr. Andrew Mendenhall, MDNPI 1053347591
Title
President & Ceo
Phone
(503) 294-1681

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

11450 SE Division St
Portland, OR 97266-1150

Mailing address

121 NW Everett St
Portland, OR 97209-4049
Phone (503) 294-1681

Other names 1

  • Cedar Commons Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241007003015 OR Part A Provider - Federally Qualified Health Center (FQHC) 6103803259 Practice locations: Portland, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366010647. Details of each certification follow.

Federally qualified health center certification: CCN 381044

Legal name
CENTRAL CITY CONCERN, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 7, 2024
Last certification
Oct 7, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 12, 1978 in OR
Enrollment address
11450 SE Division St
RM 115
Portland, OR 97266-1193

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Central City Concern Inc18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Locations

11450 SE Division St
Portland, OR 97266
Phone (503) 382-9907

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Jonathan Radmacher Individual Corporate OfficerBoard President Oct 20, 2010
Corporate DirectorBoard President Oct 20, 2010
Elisabeth Zeller Individual Corporate OfficerVice Board Chair Feb 18, 2016
Corporate DirectorVice Board Chair Feb 18, 2016
Ann Remmers Individual Corporate DirectorBoard Member Jan 15, 2025
David Swartley Individual Corporate DirectorBoard Member Aug 18, 2021
Fernando Pena Individual Corporate DirectorBoard Member Apr 19, 2023
Carrie Smith Individual Corporate DirectorBoard Member Mar 15, 2023
Andrew B Mendenhall Individual Corporate OfficerPresident & Ceo Jul 1, 2022
W-2 Managing EmployeePresident & Ceo Jul 1, 2022
Operational/Managerial ControlPresident & Ceo Jul 1, 2022
Peter Beyer Individual Corporate OfficerChief Financial Officer Sep 7, 2021
W-2 Managing EmployeeChief Financial Officer Sep 7, 2021
Operational/Managerial ControlChief Financial Officer Sep 7, 2021
Jenny Kim Individual Corporate DirectorBoard Member Aug 20, 2025
Mamie Gathard Individual Corporate DirectorBoard Member Sep 21, 2022
Katrina McPherson Individual Corporate DirectorBoard Member Feb 17, 2023
David Chen Individual Corporate OfficerGeneral Counsel Jul 6, 2021
W-2 Managing EmployeeGeneral Counsel Jul 6, 2021
Operational/Managerial ControlGeneral Counsel Jul 6, 2021
Phyusin Myint Individual Corporate DirectorBoard Member Aug 20, 2025
William Rasmussen Individual Corporate DirectorBoard Member Aug 20, 2025
Eric Fishman Individual Corporate DirectorBoard Member May 18, 2022
Stacie L Carney Individual Corporate DirectorBoard Member Oct 16, 2024
Rilla Delorier Individual Corporate OfficerBoard Secretary/Treasurer Nov 26, 2018
Corporate DirectorBoard Secretary/Treasurer Nov 26, 2018
Caresse Sakagawa Individual Corporate DirectorBoard Member Sep 20, 2023
Marguerita Lightfoot Individual Corporate DirectorBoard Member Nov 20, 2024

Owners & managing parties with NPI records 3

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

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": "1623628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775692800000",
    "number": "1366010647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 NW EVERETT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972094049",
            "telephone_number": "503-294-1681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11450 SE DIVISION ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972661150",
            "telephone_number": "503-294-1681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL CITY CONCERN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-14",
        "last_updated": "2026-04-09",
        "certification_date": "2026-04-09",
        "status": "A",
        "authorized_official_last_name": "MENDENHALL",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "503-294-1681",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cedar Commons",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.