NPIMap

Organization Active NPI

Providence Health & Services Oregon

Doing business as Providence Health Sys-OR Shared Svs Div

  • Home Health Agency
  • Medford, OR
National Provider Identifier
1487746491
Registry record updated May 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
13-140734 Issued in OR
Legal business name
PROVIDENCE HEALTH & SERVICES OREGON
Doing business as
Providence Health Sys-OR Shared Svs Div
Practice address
2033 Commerce Dr
Medford, OR 97504-9744
Phone
(541) 732-6500
Fax
(541) 732-6504
NPI assigned
Sep 28, 2006
Last updated
May 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2025

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

Authorized official

Name
Donald Wayne Anderson Jr.
Title
Assistant Secretary of Enrollments
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 13-140734 OR Primary

Addresses

Primary practice location

2033 Commerce Dr
Medford, OR 97504-9744

Mailing address

4400 NE Halsey St
Building 1, Ste 129
Portland, OR 97213-1545
Phone (503) 215-4601

Other identifiers 4

IdentifierTypeStateIssuer
930386912-05OtherORODS
026699000OtherORBLUE CROSS
303804000001OtherORPROVIDENCE HEALTH PLAN
019773MedicaidOR

Other names 1

  • Providence Health Sys-OR Shared Svs Div Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141217000873 OR Part A Provider - Home Health Agency 6305755000 Practice locations: Medford, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487746491. Details of each certification follow.

Home health agency certification: CCN 387016

Legal name
PROVIDENCE HEALTH & SERVICES OREGON
Doing business as
PROVIDENCE MEDFORD HOME CARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jul 1, 1966
Last certification
Apr 12, 2018
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Feb 20, 1934 in OR
Enrollment address
2033 Commerce Dr
Medford, OR 97504-9744

Other NPIs with the same Medicare PAC ID 8

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Providence Medford Home CareCCN 387016 · All quality measures
Overall star rating
4 of 5
Ownership
Non-Profit
Certified
Jul 1, 1966
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Providence Health Service-18 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

4400 NE Halsey St
Ste 129
Portland, OR 97213

Ownership & related parties

All disclosed owners & managing parties 26

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

NameRoleSinceShare
Diane L Hejna Individual Corporate DirectorBoard Member Jul 1, 2016
Richard S Blair Individual Corporate DirectorBoard Member Jul 1, 2016
Providence Health & Services-Oregon Organization, Renton, WA Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2016 100%
Marvin O'Quinn Individual Corporate DirectorBoard Member Jan 1, 2024
Linda Buck Individual Corporate DirectorBoard Member Jan 1, 2025
Providence Health & Services - Washington Organization, Renton, WA Corporation Operational/Managerial Control Jan 10, 2011
Erik Wexler Individual Corporate OfficerPresident Jan 1, 2023
Mary E Lyons Individual Corporate DirectorBoard Member Jul 1, 2016
Nicole Sikes Individual W-2 Managing EmployeeDirector Aug 22, 2022
Phyllis M Hughes Individual Corporate DirectorBoard Member Jan 1, 2014
Rogelio Riojas Individual Corporate DirectorBoard Member Jan 1, 2025
James Martin Individual Corporate OfficerAsst Treasurer Jan 13, 2023
Malisa J Westlund Individual W-2 Managing EmployeeChief Financial Executive Mar 6, 2020
Charles Wallace Sorenson Individual Corporate DirectorBoard Member Jan 1, 2019
Michael D Robinson Individual W-2 Managing EmployeeChief Jan 6, 2020
Donald Wayne Anderson Individual Corporate OfficerAssistant Corp Sec of Enrollment Jan 1, 2017
Gregory David Hoffman Individual Corporate OfficerEvp/Cfe Oct 1, 2020
Isiaah D Crawford Individual Corporate DirectorBoard Member Feb 1, 2012
Donna Markham Individual Corporate DirectorBoard Member Jan 1, 2024
Michael W Murphy Individual Corporate DirectorBoard Member Jan 1, 2020
Providence Health & Services Organization, Renton, WA Corporation, Non-profit Operational/Managerial Control Jul 1, 2016
Lorraine Boone Individual W-2 Managing EmployeeDirector-Medford Home Care and H Sep 1, 1998
Eric D Sprunk Individual Corporate DirectorBoard Member Jan 1, 2022
Anna R Newsom Individual Corporate OfficerCorporate Secretary May 13, 2022
Karin Dufault Individual Corporate DirectorBoard Member Jan 1, 2025
Providence St. Joseph Health Organization, Renton, WA Corporation, Non-profit Operational/Managerial Control Jul 1, 2016

Facilities with the same owner 141

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

View all 141

Practitioners & affiliated clinicians

Affiliated clinicians 45

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

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747267200000",
    "number": "1487746491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 NE HALSEY ST",
            "address_2": "BUILDING 1, STE 129",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972131545",
            "telephone_number": "503-215-4601",
            "fax_number": "503-215-4624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2033 COMMERCE DR",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975049744",
            "telephone_number": "541-732-6500",
            "fax_number": "541-732-6504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-15",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "OR",
            "license": "13-140734",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ODS",
            "identifier": "930386912-05",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "026699000",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDENCE HEALTH PLAN",
            "identifier": "303804000001",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019773",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Health Sys-OR Shared Svs Div",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.