Peacehealth

Primary specialty

Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X

License

40 0223 Issued in OR

Legal business name

PEACEHEALTH

Doing business as

Cottage Grove Community Medical CT

Practice address

1515 Village Dr
Cottage Grove, OR 97424-9700

Phone

(541) 686-7034

Fax

(541) 335-2325

NPI assigned

Mar 26, 2012

Last updated

Apr 16, 2026By the provider in NPPES

Organization subpart

Yes

Parent organization

PEACEHEALTHAs reported in NPPES

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

Authorized official

Name

Arthur Craig Springer II

Title

Sys VP Fin Integrity/Controller

Phone

(360) 729-1132

Specialties & licenses 1

Addresses

Other names 1

• COTTAGE GROVE COMMUNITY MEDICAL CT Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609142595. Details of each certification follow.

• CCN 38Z301 Hospital · Details

Hospital certification: CCN 38Z301

Legal name

PEACEHEALTH

Doing business as

COTTAGE GROVE COMMUNITY MEDICAL CENTER

Organization structure

CorporationNon-profit

Incorporated

Jun 15, 1976 in WA

Enrollment address

1515 Village Dr
Cottage Grove, OR 97424-9700
Hospital Swing-Bed Unit

Related certifications (CCN) 1

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

• Peacehealth

  dba Cottage Grove Community Medical CT

  • Critical Access Hospital
  • Cottage Grove, OR
  • NPI 1902892391

  Unit of hospital

  Provider of Services

Other NPIs with the same Medicare PAC ID 1

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

• Peacehealth

  dba Cottage Grove Community Medical CT

  • Critical Access Hospital
  • Cottage Grove, OR
  • NPI 1902892391

  1254242357

  Same PAC ID

Tax ID family

Peacehealth3 organizations share this tax ID, including this one

Part of

Peacehealth

Other organizations with this tax ID 2

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

• Peace Health

  dba Cottage Grove Community Hospital

  • Non-Pharmacy Dispensing Site
  • Cottage Grove, OR
  • NPI 1023450715
  NPD tax ID
• Peacehealth

  dba Cottage Grove Community Medical Ct

  • Rural Health Clinic/Center
  • Dexter, OR
  • NPI 1104264068
  NPD tax ID

All disclosed owners & managing parties 18

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

Owners & managing parties with NPI records 1

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

• Peacehealth

  dba Cottage Grove Community Medical CT

  • Critical Access Hospital
  • Cottage Grove, OR
  • NPI 1902892391

  5% Or Greater Direct Ownership Interest

  CMS ownership

Practitioners 4

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.

• Jeremy Brown, M.D.

  • Emergency Medicine Physician
  • Springfield, OR
  • NPI 1073957148
  Medicare reassignment NPD
• Patrick G. Hudson, M.D.

  • Emergency Medicine Physician
  • Springfield, OR
  • NPI 1831573906
  Medicare reassignment NPD
• Brian J McCarthy, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Portland, OR
  • NPI 1336461813
  Medicare reassignment NPD
• Jeffry Alan Jacobs, MEDICAL DOCTOR

  • Child & Adolescent Psychiatry Physician
  • Saint Joseph, MO
  • NPI 1063477545

  OR

  Medicare reassignment

Affiliated clinicians 2

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

• Zuzanna M. Wieckowska, M.D.

  • Family Medicine Physician
  • Cottage Grove, OR
  • NPI 1902823743

  Nursing home

  Care Compare affiliation
• Marta E Hantke, MD

  • Family Medicine Physician
  • Wichita, KS
  • NPI 1508094442

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1332720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776297600000",
    "number": "1609142595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 VILLAGE DR",
            "city": "COTTAGE GROVE",
            "state": "OR",
            "postal_code": "974249700",
            "telephone_number": "541-686-7034",
            "fax_number": "541-335-2325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 VILLAGE DR",
            "city": "COTTAGE GROVE",
            "state": "OR",
            "postal_code": "974249700",
            "telephone_number": "541-686-7034",
            "fax_number": "541-335-2325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACEHEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEACEHEALTH",
        "enumeration_date": "2012-03-26",
        "last_updated": "2026-04-16",
        "certification_date": "2026-04-16",
        "status": "A",
        "authorized_official_last_name": "SPRINGER",
        "authorized_official_first_name": "ARTHUR",
        "authorized_official_middle_name": "CRAIG",
        "authorized_official_title_or_position": "SYS VP FIN INTEGRITY/CONTROLLER",
        "authorized_official_telephone_number": "360-729-1132",
        "authorized_official_name_suffix": "II"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "OR",
            "license": "40 0223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COTTAGE GROVE COMMUNITY MEDICAL CT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lisa M Parker, FNP-BC
• Pathwise Behavioral Health, LLC
• Paws and Reflect Therapeutic Services
• Andrew Evans Paxson, PHARMD
• Peace Health (Cottage Grove Community Hospital)
• Peacehealth (South Lane Medical Group)
• Peacehealth (Cottage Grove Community Medical CT)
• Mary Peckenpaugh
• Eve Peirce, MS, LPC
• Russell Pennington

• Medicare Defined Swing Bed Hospital Unit in Cottage Grove, OR
• Providers in Cottage Grove, OR by specialty
• Medicare Defined Swing Bed Hospital Unit in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.