NPIMap

Organization Active NPI

Providence Health & Services - Oregon

Doing business as Providence Medford Medical Center

  • Rehabilitation Hospital Unit
  • Medford, OR
National Provider Identifier
1508949884
Registry record updated May 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
Legal business name
PROVIDENCE HEALTH & SERVICES - OREGON
Doing business as
Providence Medford Medical Center
Practice address
1111 Crater Lake Ave
Medford, OR 97504-6241
Phone
(503) 215-4323
Fax
(503) 215-0297
NPI assigned
Oct 23, 2006
Last updated
May 27, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HEALTH & SERVICES - OREGONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 27, 2025

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X NU Primary

Addresses

Primary practice location

1111 Crater Lake Ave
Medford, OR 97504-6241

Mailing address

PO Box 31001-4199
Pasadena, CA 91110-4199
Phone (503) 215-4323

Other identifiers 2

IdentifierTypeStateIssuer
286211MedicaidOR
0000ZGBJCOtherORPART B MEDICARE PTAN

Other names 1

  • Providence Medford Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070924000473 OR Part A Provider - Hospital 3476450560 Practice locations: Medford, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508949884. Details of each certification follow.

Hospital certification: CCN 38T075

Legal name
PROVIDENCE HEALTH & SERVICES - OREGON
Doing business as
PROVIDENCE MEDFORD MEDICAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Feb 24, 1934 in OR
Enrollment address
1111 Crater Lake Ave
Medford, OR 97504-6241
Hospital Rehabilitation Unit
Hospital subgroups
Acute care, Rehabilitation, Rehabilitation unit

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

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Providence Medford Medical CenterCCN 38T075 · All quality measures
Ownership
Non-profit
Certified
Jan 1, 1984

National Provider Directory

National Provider Directory
Tax ID family
Providence Health Service-2 organizations share this tax ID, including this one
Part of
Providence Hood River Memorial Hospital Pharmacy

Other organizations with this tax ID 1

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

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 Aug 16, 2010 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 Aug 16, 2010
Susan Sauder Individual W-2 Managing EmployeeFinance Executive Jan 1, 2025
Mary E Lyons Individual Corporate DirectorBoard Member Jul 1, 2016
Phyllis M Hughes Individual Corporate DirectorRSM Jan 1, 2014
Rogelio Riojas Individual Corporate DirectorBoard Member Jan 1, 2025
James Martin Individual Corporate Officer Jan 13, 2023
Charles Wallace Sorenson Individual Corporate DirectorBoard Member Jan 1, 2019
Donald Wayne Anderson Individual Corporate OfficerAssistant Secretary of Enrollments Jan 1, 2017
Gregory David Hoffman Individual Corporate OfficerCfo/Treasurer Jan 1, 2023
Isiaah D Crawford Individual Corporate Director Jan 1, 2012
Christopher Pizzi Individual W-2 Managing EmployeeExec, Southern Oregon Service Area Apr 18, 2012
Melissa Ann Damm Individual W-2 Managing EmployeeOregon Cfo Jul 20, 2016
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 Non-profit Other Jul 1, 2016
Mary Beth Kingston Individual Corporate Director Sep 1, 2022
Eric D Sprunk Individual Corporate Director Jan 1, 2022
Anna R Newsom Individual Corporate Officer May 13, 2022
Darryl Elmouchi Individual Corporate OfficerPresident/Ceo Apr 1, 2025
Karin Dufault Individual Corporate DirectorBoard Member Jan 1, 2025
Providence St. Joseph Health Organization, Renton, WA Corporation, Non-profit Other Jul 1, 2016

Owners & managing parties with NPI records 1

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

Facilities with the same owner 139

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

View all 139

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 11

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": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748304000000",
    "number": "1508949884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-4199",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104199",
            "telephone_number": "503-215-4323",
            "fax_number": "503-215-0297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 CRATER LAKE AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046241",
            "telephone_number": "503-215-4323",
            "fax_number": "503-215-0297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "enumeration_date": "2006-10-23",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "286211",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PART B MEDICARE PTAN",
            "identifier": "0000ZGBJC",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Medford Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Medford Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.