NPIMap

Organization Active NPI

County of Jackson

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Medford, OR
National Provider Identifier
1710933379
Registry record updated Dec 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
COUNTY OF JACKSON
Practice address
140 South Holly Street
Medford, OR 97501
Phone
(541) 774-8200
Fax
(541) 774-7964
NPI assigned
May 25, 2006
Last updated
Dec 11, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2014

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

Authorized official

Name
Mr. Mark Jerry Orndoff, MS SOCIAL SCIENCE
Title
Director
Phone
(541) 774-8200

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X 200250069NP OR
Ambulatory Family Planning Facility 261QA0005X NU
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X OR Primary
Methadone Clinic 261QM2800X NU
Case Manager/Care Coordinator 171M00000X NU

Addresses

Primary practice location

140 South Holly Street
Medford, OR 97501

Mailing address

140 South Holly Street
Medford, OR 97501
Phone (541) 774-8200

Other identifiers 5

IdentifierTypeStateIssuer
193870MedicaidOR
096883MedicaidOR
096727MedicaidOR
320176MedicaidOR
043153MedicaidOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040226000541 OR Part B Supplier - Clinic/Group Practice 2961398821 Receives reassigned benefits from 9 practitioners
Practice locations: Medford, OR

National Provider Directory

National Provider Directory
Tax ID family
Jackson County Oregon8 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Practitioners & affiliated clinicians

Practitioners 9

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": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418256000000",
    "number": "1710933379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 SOUTH HOLLY STREET",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "97501",
            "telephone_number": "541-774-8200",
            "fax_number": "541-774-7964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 SOUTH HOLLY STREET",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "97501",
            "telephone_number": "541-774-8200",
            "fax_number": "541-774-7964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF JACKSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2014-12-11",
        "status": "A",
        "authorized_official_last_name": "ORNDOFF",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "JERRY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "541-774-8200",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS SOCIAL SCIENCE"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "OR",
            "license": "200250069NP",
            "primary": false
        },
        {
            "code": "261QA0005X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Family Planning Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "OR",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "193870",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "096883",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "096727",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "320176",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "043153",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.