Benton County
Organization Active NPI Federally Qualified Health Center (FQHC) · Alsea, OR
NPI 1588046791 · NPPES record last updated May 1, 2025
Key facts
- NPI
- 1588046791
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- BENTON COUNTY
- Practice address
- 435 E Alder St
Alsea, OR 97324-9634 - Phone
- (541) 487-7116
- Fax
- (541) 487-4076
- NPI assigned
- Jun 24, 2015
- Organization subpart
- Yes
- Parent organization (as reported)
- BENTON COUNTY
Authorized official
- Name
- Lacey Mollel
- Title
- Health Center Director
- Phone
- (541) 766-6835
Parent organization (reported in NPPES) 1
Owners & managing parties with NPI records 5
Owned or controlled facilities with NPI records 5
Other NPIs with the same Medicare PAC ID 5
Corporate family (same tax ID) 12
Facilities with the same owner 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Federally qualified health center certification: CCN 381969
- Legal name
- BENTON COUNTY
- Doing business as
- BENTON COUNTY HEALTH SERVICES
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Nov 9, 2015
- Last certification
- Nov 9, 2015
- Ownership / control type
- For profit – corporation
- Organization structure
- Government · Non-profit
- Incorporated
- Dec 23, 1847 in OR
- Enrollment address
- 435 E Alder St
Alsea, OR 97324-9634
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Sandra L Smith |
W-2 Managing Employee |
Sep 1, 2019 | |
| Morry L McClintock |
Corporate Officer |
Nov 1, 2015 | |
| W-2 Managing Employee |
Aug 7, 2006 | ||
| Sherlyn R Dahl |
Corporate Director |
Aug 7, 2006 | |
| W-2 Managing Employee |
Aug 7, 2006 | ||
| Benton County |
5% Or Greater Direct Ownership Interest | Nov 1, 2015 | 100% |
All facility ownership & control disclosures 5
| Facility | Type | Role | Since |
|---|---|---|---|
| Benton County Health Services |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | May 4, 2004 |
| Benton County Health Services |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 4, 2004 |
| Benton County Health Services |
Federally qualified health center | Operational/Managerial Control (100%) | Oct 1, 2004 |
| Benton County Health Services |
Federally qualified health center | Operational/Managerial Control (100%) | Oct 1, 2004 |
| Benton County Health Services |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Dec 1, 2015 Jul 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20151211001064 | OR | Part a Provider - Federally Qualified Health Center (FQHC) | 6709858020 | Practice locations: Alsea, OR |
National Provider Directory
- Tax ID family
- Benton County Health de
- Part of
- Benton County Health de
Locations
110 SE Alexander Ave
Corvallis, OR 97333
Phone (541) 757-5811
600 Dragon Dr
Monroe, OR 97456
Phone (541) 766-3546
610 Dragon Dr
Monroe, OR 97456
Phone (541) 766-6000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
435 E Alder St
Alsea, OR 97324-9634
Mailing address
PO Box 579
Corvallis, OR 97339-0579
Phone (541) 766-6190
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 227701 | Medicaid | OR |
Other names
- Benton County Health Services
Other providers in Alsea, OR
- Alsea Rural Health Care, Inc.
- Sarah Nicole Barbuto
- Benton County School District 7J
- Mary Ann Carr
- Joy Cavatorta
- Danielle Elbers
- Sherri Jeanne France
All providers in Alsea, OR · Federally Qualified Health Center (FQHC) in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.