NPIMap

Organization Active NPI

Providence Health & Services Oregon

Doing business as Providence Seaside Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Seaside, OR
National Provider Identifier
1558435362
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
PROVIDENCE HEALTH & SERVICES OREGON
Doing business as
Providence Seaside Hospital
Practice address
725 S Wahanna Rd
Seaside, OR 97138-7735
Phone
(503) 717-7000
NPI assigned
Nov 20, 2006
Last updated
Apr 29, 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 Apr 29, 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
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

Addresses

Primary practice location

725 S Wahanna Rd
Seaside, OR 97138-7735

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
0000ZGBGTOtherORPART B MEDICARE PTAN

Other names 1

  • Providence Seaside Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071003000370 OR Part A Provider - Critical Access Hospital 1557260106 Practice locations: Seaside, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1558435362. Details of each certification follow.

Hospital certification: CCN 38Z303

Legal name
PROVIDENCE HEALTH & SERVICES OREGON
Doing business as
PROVIDENCE SEASIDE HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Feb 24, 1934 in OR
Enrollment address
725 S Wahanna Rd
Seaside, OR 97138-7735
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Providence Health Serivces3 organizations share this tax ID, including this one
Part of
Providence Portland Medical Center

Other organizations with this tax ID 2

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 May 14, 2010
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 Non-profit Operational/Managerial Control May 14, 2010
Mary E Lyons Individual Corporate DirectorBoard Member Jul 1, 2016
Phyllis M Hughes Individual Corporate DirectorDirector 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
Pamela J Cooper Individual W-2 Managing EmployeeDirector-Finance Sep 1, 1998
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 DirectorDirector Jan 1, 2012
Melissa Ann Damm Individual W-2 Managing EmployeeOregon Cfo Jul 20, 2016
Rebecca F Coplin Individual W-2 Managing EmployeeService Area Executive Jan 1, 2025
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 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

Affiliated clinicians 3

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": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745884800000",
    "number": "1558435362",
    "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": "725 S WAHANNA RD",
            "city": "SEASIDE",
            "state": "OR",
            "postal_code": "971387735",
            "telephone_number": "503-717-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES OREGON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HEALTH & SERVICES  OREGON",
        "enumeration_date": "2006-11-20",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-21",
        "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": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PART B MEDICARE PTAN",
            "identifier": "0000ZGBGT",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Seaside Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Seaside Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seaside, OR

Sources for this page

Verify at the official NPI Registry.