NPIMap

Organization Active NPI

Southern Coos Health District

Doing business as Southern Coos Hospital & Health Center

  • Critical Access Hospital
  • Bandon, OR
National Provider Identifier
1417094145
Registry record updated Oct 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
140809 Issued in OR
Legal business name
SOUTHERN COOS HEALTH DISTRICT
Doing business as
Southern Coos Hospital & Health Center
Practice address
900 11TH St SE
Bandon, OR 97411-9114
Phone
(541) 347-2426
Fax
(541) 347-3923
NPI assigned
Jan 31, 2007
Last updated
Oct 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2024

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

Authorized official

Name
Antone J Eek
Title
Authorized Official - Cfo
Phone
(503) 544-6592

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 140809 OR Primary

Addresses

Primary practice location

900 11TH St SE
Bandon, OR 97411-9114

Mailing address

900 11TH St SE
Bandon, OR 97411-9114
Phone (541) 347-2426

Other identifiers 1

IdentifierTypeStateIssuer
800004MedicaidOR

Other names 1

  • SOUTHERN COOS HOSPITAL & HEALTH CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120331000085 OR Part A Provider - Critical Access Hospital 1951219310 Receives reassigned benefits from 1 practitioner
Practice locations: Bandon, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417094145. Details of each certification follow.

Hospital certification: CCN 38Z304

Legal name
SOUTHERN COOS HEALTH DISTRICT
Doing business as
SOUTHERN COOS HOSPITAL & HEALTH CENTER
Organization structure
OtherNon-profit
Enrollment address
900 11TH St SE
Bandon, OR 97411-9114
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Southern Coos Hospital3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

913 11th St SE
Bandon, OR 97411
Phone (435) 650-5735

Interoperability endpoints

  • Direct secure messaging: ehr-direct@southerncoos.hin.us

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
Antone Eek Individual Corporate OfficerCfo May 1, 2024
David Allen Individual Corporate DirectorBoard Member Oct 1, 2004
Southern Coos Health District Organization, Bandon, OR Operational/Managerial Control Nov 21, 2007 100%
Other Nov 21, 2007 100%
Julie C Mann Individual W-2 Managing EmployeeCycle Revenue Manager Nov 1, 2017
Raymond T Hino Individual Corporate OfficerCeo Feb 21, 2022

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Southern Coos Hospital & Health CenterBandon, OR, CCN 381304 Hospital Operational/Managerial Control (100%)
Other (100%)		 Nov 21, 2007
Nov 21, 2007

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 52

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 52

Affiliated clinicians 7

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": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727913600000",
    "number": "1417094145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 11TH ST SE",
            "city": "BANDON",
            "state": "OR",
            "postal_code": "974119114",
            "telephone_number": "541-347-2426",
            "fax_number": "541-347-3923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 11TH ST SE",
            "city": "BANDON",
            "state": "OR",
            "postal_code": "974119114",
            "telephone_number": "541-347-2426",
            "fax_number": "541-347-3923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN COOS HEALTH DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A",
        "authorized_official_last_name": "EEK",
        "authorized_official_first_name": "ANTONE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL - CFO",
        "authorized_official_telephone_number": "503-544-6592"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "OR",
            "license": "140809",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "800004",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTHERN COOS HOSPITAL & HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bandon, OR

Sources for this page

Verify at the official NPI Registry.