NPIMap

Organization Active NPI

Mosaic Medical

Doing business as Mosaic Medical Prineville

  • Federally Qualified Health Center (FQHC)
  • Prineville, OR
National Provider Identifier
1679811954
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 Prineville
Practice address
375 NW Beaver St
Suite 101
Prineville, OR 97754-1802
Phone
(541) 447-0707
Fax
(541) 383-1883
NPI assigned
Jan 22, 2013
Last updated
Apr 19, 2016By the provider in NPPES
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, FNPNPI 1952411811
Title
Ceo
Phone
(541) 447-0707

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

375 NW Beaver St
Suite 101
Prineville, OR 97754-1802

Mailing address

600 SW Columbia St
Suite 6210
Bend, OR 97702-1099
Phone (541) 447-0707

Other identifiers 1

IdentifierTypeStateIssuer
182960MedicaidOR

Other names 1

  • Mosaic Medical Prineville Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mosaic Medical28 organizations share this tax ID, including this one
Part of
Mosaic Medical

Other organizations with this tax ID 27

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

View all 27

Practitioners & affiliated clinicians

Practitioners 1

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": "1358812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461024000000",
    "number": "1679811954",
    "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": "541-447-0707",
            "fax_number": "541-447-0708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 NW BEAVER ST",
            "address_2": "SUITE 101",
            "city": "PRINEVILLE",
            "state": "OR",
            "postal_code": "977541802",
            "telephone_number": "541-447-0707",
            "fax_number": "541-383-1883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSAIC MEDICAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOSAIC MEDICAL",
        "enumeration_date": "2013-01-22",
        "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": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182960",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mosaic Medical Prineville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prineville, 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.