NPIMap

Organization Active NPI

Mosaic Medical

Doing business as Mosaic Medical Ensworth School Based Health Center

  • Federally Qualified Health Center (FQHC)
  • Bend, OR
National Provider Identifier
1649681560
Registry record updated Apr 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MOSAIC MEDICAL
Doing business as
Mosaic Medical Ensworth School Based Health Center
Practice address
2150 NE Daggett LN
Bend, OR 97701-6560
Phone
(541) 323-3850
Fax
(541) 383-1883
NPI assigned
May 13, 2014
Organization subpart
Yes
Parent organization
MOSAIC MEDICALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 19, 2016

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

Authorized official

Name
Megan Haase, NP
Title
Ceo
Phone
(541) 447-0707

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

2150 NE Daggett LN
Bend, OR 97701-6560

Mailing address

600 SW Columbia St
Suite 6210
Bend, OR 97702-1099
Phone (541) 323-3181

Other identifiers 1

IdentifierTypeStateIssuer
182960MedicaidOR

Other names 1

  • Mosaic Medical Ensworth School Based Health Center Doing business as

National Provider Directory

National Provider Directory
Part of
Mosaic Medical

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1399939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461024000000",
    "number": "1649681560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 SW COLUMBIA ST",
            "address_2": "SUITE 6210",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021099",
            "telephone_number": "541-323-3181",
            "fax_number": "541-706-9895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 NE DAGGETT LN",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016560",
            "telephone_number": "541-323-3850",
            "fax_number": "541-383-1883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSAIC MEDICAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOSAIC MEDICAL",
        "enumeration_date": "2014-05-13",
        "last_updated": "2016-04-19",
        "status": "A",
        "authorized_official_last_name": "HAASE",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-447-0707",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182960",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mosaic Medical Ensworth School Based Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.