Grande Ronde Hospital, Inc
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · La Grande, OR
NPI 1609980655 · NPPES record last updated Dec 16, 2019
Key facts
- NPI
- 1609980655
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- License
- 394792 (OR)
- Legal business name
- GRANDE RONDE HOSPITAL, INC
- Practice address
- 900 Sunset Dr
La Grande, OR 97850-1362 - Phone
- (541) 963-8421
- Fax
- (541) 963-1845
- NPI assigned
- Aug 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Angela J Hibbert
- Title
- Credentialing Coordinator
- Phone
- (541) 963-1967
Owners & managing parties with NPI records 10
-
Stephen McLean, DMD
Owned or controlled facilities with NPI records 6
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 10
Related certifications (CCN) 4
Facilities with the same owner 5
Practitioners 97
-
Lynda Anne Hatley, APRN, FNP-C
-
Maricela Elena Bandel-Ramirez, AGACNP
-
Andrew Dale Baum, DPM
-
Raffaella Sappe Betza, M.D.
-
Debora Brown-Cumpton, LCSW
-
Marcus Paul Carr, M.D.
-
Bradley Robert Close, CRNA
-
Aaron Randy Cooper, PA-C
-
Brooke Davis, DO
-
Gerry F Funk, MD
-
Geraldine Gardner, D.O.
-
Blake Gornowicz, MD
-
Jamie Jo Haddock, NP-C
-
Ellen Faye Hills, NP
-
Heather Holland, MSW, LCSW
-
Jared Johnathan Hulme, APRN, DNP, FNP-C
-
Leslie W Jackson, MD
-
Zachary Michael Jacobsen, CRNA
-
Jesse Jarnes, CRNA
Affiliated clinicians 4
-
Maricela Elena Bandel-Ramirez, AGACNP
-
Blake Gornowicz, MD
-
Kim A Myers, FNP, AGACNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Hospital certification: CCN 38Z321
- Legal name
- GRANDE RONDE HOSPITAL INC
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 1, 1986 in OR
- Enrollment address
- 900 Sunset Dr
La Grande, OR 97850-1387
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Stephen M McLean |
Corporate Director | Jan 1, 2016 | |
| Grande Ronde Hospital Inc |
Operational/Managerial Control | May 31, 1966 | |
| Stacy Whitaker |
Corporate Director | Jan 1, 2018 | |
| Bradley D Trisler |
Corporate Director | Jan 1, 2010 | |
| Samuel H Kimball |
Corporate Director | Feb 22, 2017 | |
| Michael a Hetrick |
Corporate Director | Jan 1, 2016 | |
| Suzanne D Hopper |
Corporate Director | Jan 1, 2015 | |
| Carla M Hagen |
Corporate Director | Feb 22, 2017 | |
| Robert P Seymour |
W-2 Managing Employee | Dec 30, 2016 | |
| Lara Kay Moore |
Corporate Director | Nov 16, 2016 | |
| John Garlitz |
Corporate Director | Jan 1, 2016 | |
| Jeremy P Davis |
Corporate Officer |
Nov 26, 2018 | |
| W-2 Managing Employee |
Nov 26, 2018 | ||
| Teri S Champlin |
Corporate Director | Jan 1, 2014 | |
| Floyd S Lyon |
Corporate Director | Jan 1, 2009 | |
| Michael E Billman |
Corporate Director | Jan 1, 2019 | |
| Libby H Goben |
Corporate Director | Jan 1, 2008 |
All facility ownership & control disclosures 5
| Facility | Type | Role | Since |
|---|---|---|---|
| Grande Ronde Hospital Regional Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Nov 1, 2005 |
| Grande Ronde Hospital Women'S & Children'S Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Nov 1, 1996 |
| Grande Ronde Hospital Union Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Nov 1, 2005 |
| Grande Ronde Hospital Elgin Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Nov 1, 2005 |
| Grande Ronde Hospital Urgent Care |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Sep 14, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071003000388 | OR | Part a Provider - Critical Access Hospital | 0547170789 |
Receives reassigned benefits from 1 practitioner 1 other NPI on this enrollment Practice locations: La Grande, OR |
National Provider Directory
- Tax ID family
- Robert Fuller MD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 394792 | OR | Yes |
Addresses
Primary practice location
900 Sunset Dr
La Grande, OR 97850-1362
Mailing address
PO Box 3290
La Grande, OR 97850-7290
Phone (541) 963-8421
Other names
- Grande Ronde Hospital
- Grande Ronde Hospital Swing Bed
Other providers in La Grande, OR
- Grande Ronde Hospital
- Grande Ronde Hospital Home Oxygen
- Grande Ronde Hospital Inc.
- Grande Ronde Hospital, Inc
- Grande Ronde Hospital, Inc
- Grande Ronde Hospital, Inc
- Grande Ronde Hospital, Inc.
- Grande Ronde Hospital, Inc.
- Grande Ronde Hospital, Inc.
- Grande Ronde Hospital, Inc.
All providers in La Grande, OR · Medicare Defined Swing Bed Hospital Unit in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 16, 2019. 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.