NPIMap

Organization Active NPI

Umpqua Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Drain, OR
National Provider Identifier
1649469909
Registry record updated Jun 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
UMPQUA COMMUNITY HEALTH CENTER, INC.
Practice address
316 W. a Street
Drain, OR 97435
Phone
(541) 836-7155
Fax
(541) 836-7157
NPI assigned
Oct 23, 2007
Last updated
Jun 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2022

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

Authorized official

Name
KC Bolton
Title
Ceo
Phone
(541) 672-9596

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

316 W. a Street
Drain, OR 97435

Mailing address

150 Kenneth Ford Drive
Rosenburg, OR 97470-1042
Phone (541) 672-9596

Other identifiers 1

IdentifierTypeStateIssuer
168395MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040511000463 OR Part B Supplier - Clinic/Group Practice 0345233078 Receives reassigned benefits from 56 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Roseburg, OR; Sutherlin, OR; Myrtle Creek, OR; Glide, OR; Drain, OR
O20090811000673 OR Part A Provider - Federally Qualified Health Center (FQHC) 0345233078 Practice locations: Drain, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649469909. Details of each certification follow.

Federally qualified health center certification: CCN 931005

Legal name
UMPQUA COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 25, 2019
Last certification
Jul 25, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 19, 2001 in OR
Enrollment address
316 W a Ave
Drain, OR 97435-0017

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 7

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2298120Umpqua Community Health Inc316 West a Avenue, Drain, OR 97435Provider-performed microscopyJan 28, 2028

National Provider Directory

National Provider Directory
Tax ID family
Open Door Clinic9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

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.

NameRoleSinceShare
Renee Coen Individual Corporate Director Jan 24, 2024
Ryan Dunbar Individual Corporate Director Mar 27, 2024
Tamara J Heppner Individual Corporate DirectorBoard Member Feb 22, 2017
Nicholas Jones Individual Corporate Director May 26, 2021
Joel Goodwillie Individual Corporate Director Feb 28, 2024
Stephen Loosley Individual Corporate Director Feb 26, 2020
Nichole M Louder Individual Corporate DirectorBoard Member Nov 30, 2016
Greg Henderson Individual Corporate Director Apr 24, 2024
Melanie McKee Individual W-2 Managing EmployeeOperating Revenue Manager Oct 17, 2014
Mindy M McFerrin Individual Corporate DirectorBoard Member Mar 30, 2016
Gwendolyn K Graham Individual Corporate DirectorBoard Member Nov 30, 2016
Ruth Galster Individual Corporate DirectorBoard Member Jul 24, 2013
Jodee Jackson Individual Corporate DirectorBoard Member Jun 30, 2017
Christine Goodwin Individual Corporate Director Sep 10, 2022
Karl C Bolton Individual Corporate OfficerChief Executive Officer Aug 23, 2016
Leah Hamilton Individual W-2 Managing EmployeeController Oct 19, 2017
Ryan Paul Melton Individual Corporate Director Nov 23, 2022
Jon Petersen Individual Corporate Director Feb 22, 2023

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Open Door ClinicSutherlin, OR, CCN 381954 Federally qualified health center Operational/Managerial Control Mar 1, 2014

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1193097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656374400000",
    "number": "1649469909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 KENNETH FORD DRIVE",
            "city": "ROSENBURG",
            "state": "OR",
            "postal_code": "974701042",
            "telephone_number": "541-672-9596",
            "fax_number": "541-464-3519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 W. A STREET",
            "city": "DRAIN",
            "state": "OR",
            "postal_code": "97435",
            "telephone_number": "541-836-7155",
            "fax_number": "541-836-7157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UMPQUA COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-23",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A",
        "authorized_official_last_name": "BOLTON",
        "authorized_official_first_name": "KC",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-672-9596"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168395",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Drain, OR

Sources for this page

Verify at the official NPI Registry.