NPIMap

Organization Active NPI

Northwest Medical Foundation of Tillamook

Doing business as Tillamook Medical Group Long Prairie Primary Care

  • Critical Access Hospital
  • Tillamook, OR
National Provider Identifier
1699146159
Registry record updated Apr 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
141177 Issued in OR
Legal business name
NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK
Doing business as
Tillamook Medical Group Long Prairie Primary Care
Practice address
5995 Long Prairie Rd
Tillamook, OR 97141-9689
Phone
(503) 842-2561
NPI assigned
Oct 9, 2015
Last updated
Apr 8, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHWEST MEDICAL FOUNDATION OF TILLAMOOKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 8, 2016

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

Authorized official

Name
Mr. Walter A Larson
Title
Vice President Finance
Phone
(503) 815-2263

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 141177 OR Primary

Addresses

Primary practice location

5995 Long Prairie Rd
Tillamook, OR 97141-9689

Mailing address

1000 3Rd St
Tillamook, OR 97141-3430
Phone (503) 842-4444

Other names 1

  • Tillamook Medical Group Long Prairie Primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061104000229 OR Part A Provider - Critical Access Hospital 5092619569 Receives reassigned benefits from 113 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tillamook, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699146159. Details of each certification follow.

Hospital certification: CCN 381317

Legal name
NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK
Doing business as
ADVENTIST HEALTH TILLAMOOK
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 29, 2004
Last certification
Nov 15, 2019
Beds
49 (25 certified)
Ownership / control type
Church
Organization structure
CorporationNon-profit
Incorporated
Aug 15, 1973 in OR
Enrollment address
1000 3Rd St
Tillamook, OR 97141-3430
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Adventist Health TillamookCCN 381317 · All quality measures
Overall star rating
4 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Tillamook Cty General7 organizations share this tax ID, including this one
Part of
Tillamook Cty General

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 20

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Micah P Smith Individual Corporate OfficerFinance Officer/Treasurer Oct 1, 2017
W-2 Managing EmployeeCfo Oct 1, 2017
Kerry L Heinrich Individual Corporate OfficerChair Jan 1, 2022
Corporate DirectorBoard Member Dec 15, 2014
Regina F Seufert Individual Corporate OfficerVP,Physician, & Clinic Services Jul 1, 2017
W-2 Managing EmployeeVP,Physician, & Clinic Services Jul 1, 2017
John H Cress Individual Corporate DirectorBoard Member Oct 1, 2024
Meredith S Jobe Individual Corporate OfficerSecretary Mar 31, 2014
Eric a Stevens Individual Corporate OfficerVice Chair Mar 5, 2025
Richard K Reiner Individual Corporate DirectorBoard Member Jan 16, 2017
Joy a. Fehr Individual Corporate DirectorBoard Member Oct 1, 2020
Jonathan J Daggett Individual Corporate DirectorBoard Member Jan 1, 2024
Andrew R Davis Individual Corporate DirectorBoard Member May 5, 2017
Ann K Beckett Individual Corporate DirectorBoard Member Jan 1, 2024
Marc K Woodson Individual Corporate DirectorBoard Member Jan 1, 2019
John C Freedman Individual Corporate DirectorBoard Member Sep 26, 2016
Jack W Wagner Individual Corporate DirectorBoard Member Dec 1, 2022
Eric Swanson Individual Corporate OfficerPresident Sep 9, 2019
W-2 Managing Employee Sep 9, 2019
Kenneth Jutzy Individual Corporate DirectorBoard Member Jan 1, 2024
Bradford C Newton Individual Corporate DirectorBoard Member Aug 16, 2021
Robert a Cherry Individual Corporate DirectorBoard Member May 5, 2017
Larry L Innocent Individual Corporate DirectorBoard Member Sep 19, 2011
Adventist Health System/West Organization, Roseville, CA Corporation, Non-profit Operational/Managerial Control Jun 16, 1980 100%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 20

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 20

Affiliated clinicians 254

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 254

NPI Registry JSON

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

{
    "created_epoch": "1444348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460073600000",
    "number": "1699146159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 3RD ST",
            "city": "TILLAMOOK",
            "state": "OR",
            "postal_code": "971413430",
            "telephone_number": "503-842-4444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5995 LONG PRAIRIE RD",
            "city": "TILLAMOOK",
            "state": "OR",
            "postal_code": "971419689",
            "telephone_number": "503-842-2561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK",
        "enumeration_date": "2015-10-09",
        "last_updated": "2016-04-08",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "VICE PRESIDENT FINANCE",
        "authorized_official_telephone_number": "503-815-2263",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "OR",
            "license": "141177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tillamook Medical Group Long Prairie Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tillamook, OR

Sources for this page

Verify at the official NPI Registry.