NPIMap

Organization Active NPI

Providence Health & Services - Oregon

Doing business as Providence Medical Group South

  • Internal Medicine Physician
  • Central Point, OR
National Provider Identifier
1609951649
Registry record updated Nov 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PROVIDENCE HEALTH & SERVICES - OREGON
Doing business as
Providence Medical Group South
Practice address
870 S Front St
Suite 200
Central Point, OR 97502-2779
Phone
(541) 732-8000
Fax
(541) 732-3404
NPI assigned
Oct 26, 2006
Last updated
Nov 19, 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 Nov 19, 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 Enrollments
Phone
(425) 358-9786

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

870 S Front St
Suite 200
Central Point, OR 97502-2779

Mailing address

PO Box 31001 - 4180
Pasadena, CA 91110-4180
Phone (503) 215-6494

Other identifiers 2

IdentifierTypeStateIssuer
288507MedicaidOR
CG6801OtherORRAILROAD MEDICARE

Other names 1

  • PROVIDENCE MEDICAL GROUP SOUTH Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040310000315 OR Part B Supplier - Clinic/Group Practice 5294623245 Receives reassigned benefits from 200 practitioners
25 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Central Point, OR; Medford, OR; Grants Pass, OR; Eagle Point, OR

Other NPIs on the same Medicare enrollment 25

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 25

National Provider Directory

National Provider Directory
Part of
Providence Health Service-

Locations (25 of 31)

1661 Highway 99 N
Ashland, OR 97520

1661 Highway 99 N
Ste 100
Ashland, OR 97520
Phone (541) 732-8300

900 S Front St
Central Point, OR 97502

1332 S Shasta Ave
Eagle Point, OR 97524

1619 NW Hawthorne Ave
Ste 206
Grants Pass, OR 97526
Phone (541) 479-5324

16180 SE Sunnyside Rd
Ste 102
Happy Valley, OR 97015
Phone (503) 582-4900

16180 SE Sunnyside Rd
Ste 203
Happy Valley, OR 97015

265 SE Oak St
Hillsboro, OR 97123
Phone (503) 215-2300

1108 June St
Hood River, OR 97031
Phone (541) 386-5070

725 N 5th St
Jacksonville, OR 97530

4004 Kruse Way Pl
Lake Oswego, OR 97035

1111 Crater Lake Ave
Ste A
Medford, OR 97504

1750 E Barnett Rd
Medford, OR 97504
Phone (541) 772-8378

70 Bower Dr
Ste 220
Medford, OR 97501
Phone (541) 732-3271

70 Bower Dr
Ste 240
Medford, OR 97501
Phone (541) 732-8360

935 Ellendale Dr
Medford, OR 97504

940 Royal Ave
Medford, OR 97504
Phone (541) 732-7000

205 N Phoenix Rd
Ste A
Phoenix, OR 97535
Phone (541) 535-1274

1235 NE 47th Ave
Ste 129
Portland, OR 97213
Phone (503) 215-2654

1321 NE 99th Ave
Portland, OR 97220

417 SW 117th Ave
#2
Portland, OR 97225

4805 NE Glisan St
Ste BGO5
Portland, OR 97213
Phone (503) 215-2393

4816 NW Bethany Blvd
Portland, OR 97229
Phone (503) 439-9014

5050 NE Hoyt St
Ste 315
Portland, OR 97213
Phone (503) 215-8580

5050 NE Hoyt St
Ste 540
Portland, OR 97213
Phone (503) 215-6600

Practitioners & affiliated clinicians

Practitioners 96

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.

View all 96

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763510400000",
    "number": "1609951649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001 - 4180",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104180",
            "telephone_number": "503-215-6494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "870 S FRONT ST",
            "address_2": "SUITE 200",
            "city": "CENTRAL POINT",
            "state": "OR",
            "postal_code": "975022779",
            "telephone_number": "541-732-8000",
            "fax_number": "541-732-3404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "enumeration_date": "2006-10-26",
        "last_updated": "2025-11-19",
        "certification_date": "2025-11-19",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "288507",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CG6801",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE MEDICAL GROUP SOUTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Central Point, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.