NPIMap

Organization Active NPI

Praxis Health, PC

  • Rural Health Clinic/Center
  • Pendleton, OR
National Provider Identifier
1386145993
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
2450 SW Perkins Ave
Pendleton, OR 97801-4302
Phone
(541) 276-1700
Fax
(541) 276-6327
NPI assigned
Feb 28, 2018
Organization subpart
No

Owners & managing parties with NPI records 1

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

Other NPIs with the same Medicare PAC ID 4

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

Facilities with the same owner 3

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

Practitioners 174

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

View all 174

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D0895265Pendleton Family Medicine2450 SW Perkins Ave, Pendleton, OR 97801Provider-performed microscopyDec 31, 2027

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180529002353 OR Part A Provider - Rural Health Clinic 8325941446 Practice locations: Pendleton, OR

Rural health clinic certification: CCN 383901

Legal name
PRAXIS HEALTH PC
Doing business as
PENDLETON FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 19, 2019
Last certification
Aug 8, 2019
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Nov 5, 1996 in OR
Enrollment address
2450 SW Perkins Ave
Pendleton, OR 97801-4302

All disclosed owners & managing parties 5

Medicare enrollment files

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

NameRoleSinceShare
McKenzie C Kennedy Individual Corporate OfficerDirector - Special Projects Jul 1, 2016
W-2 Managing EmployeeDirector - Special Projects Jan 1, 1996
Garrett Kennedy Individual Corporate OfficerCeo Jan 1, 2016
Corporate DirectorDirector/Secretary Jan 1, 1996
Stephen a Mann Individual Corporate DirectorPresident/Director Jan 1, 1996
Adaugeo Healthcare Solutions LLC Organization, Pendleton, OR LLC 5% Or Greater Direct Ownership Interest Dec 1, 2007 99%
Operational/Managerial Control Dec 1, 2007
Jessica Morgan Individual Corporate DirectorBRD MBR/Director Jan 1, 1996

National Provider Directory

National Provider Directory
Tax ID family
Praxis Medical Group Inc7 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.

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 Primary

Addresses

Primary practice location

2450 SW Perkins Ave
Pendleton, OR 97801-4302

Mailing address

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

Other names 2

  • Pendleton Family Medicine Doing business as
  • PRAXIS MEDICAL GROUP, INC. Former legal business name

NPI Registry JSON

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

{
    "created_epoch": "1519776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630281600000",
    "number": "1386145993",
    "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": "2450 SW PERKINS AVE",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978014302",
            "telephone_number": "541-276-1700",
            "fax_number": "541-276-6327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAXIS HEALTH, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-28",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pendleton Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pendleton Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PRAXIS MEDICAL GROUP, INC.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Pendleton, OR

Sources for this page

Verify at the official NPI Registry.