Rogue Community Health
Organization Active NPI Federally Qualified Health Center (FQHC) · White City, OR
NPI 1740733286 · NPPES record last updated Oct 31, 2023
Key facts
- NPI
- 1740733286
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- ROGUE COMMUNITY HEALTH
- Practice address
- 550 Wilson Way
White City, OR 97503-1351 - Phone
- (541) 830-6315
- Fax
- (541) 830-6751
- NPI assigned
- Aug 2, 2016
- Organization subpart
- No
Authorized official
- Name
- Calisa N Warnke
- Title
- Cfo
- Phone
- (541) 842-7642
Owners & managing parties with NPI records 1
-
Eric Seth Webb, MD
Other NPIs on the same Medicare enrollment 10
Other NPIs with the same Medicare PAC ID 10
Practitioners 32
-
Allyson Aimers, FNP
-
Malinda Barclay, LCSW
-
Karen Barnard, LCSW
-
Kecia Caldwell, MS, RD, LDN
-
Clarissa Evanell Carson, PMHNP
-
Kiara Grace Elkin, PA-C
-
Debra Rae Frost, FNP-C
-
Anne E. Graham, FNP-BC, MSN, FACCWS
-
Mario Guzman, LPC
-
Tom David Hazel, FNP
-
Tajinder Singh Heer, M.D.
-
Wayne Hoagland, LPC
-
Danielle H Holtz, MD
-
Sara Kinney, FNP
-
Taylor Krehbiel, LPC
-
Paul D. Matz, MD
-
Autumn Polidor, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OR
Federally qualified health center certification: CCN 381977
- Legal name
- ROGUE COMMUNITY HEALTH
- Doing business as
- WHITE MOUNTAIN HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Feb 28, 2017
- Last certification
- Feb 28, 2017
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 20, 1974 in OR
- Enrollment address
- 550 Wilson Way
White City, OR 97503-1351
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Nancy S Nordyke |
Corporate Director | Jan 1, 2023 | |
| Johnathan Caldwell |
Corporate Director | Jan 1, 2023 | |
| Eric Webb |
Corporate Director | Jan 1, 2026 | |
| John F. Mytinger |
Corporate Director |
Jul 1, 2015 | |
| Gloria Barrios |
Corporate Director | Jan 1, 2026 | |
| Nate Sickler |
Corporate Director | Jan 1, 2023 | |
| Martha Miller |
Corporate Director | Jan 1, 2023 | |
| Doug D McKenzie |
Corporate Director |
Feb 27, 2014 | |
| Stick Crosby |
Corporate Director | Jan 1, 2026 | |
| Calisa Noorda Warnke |
Corporate Officer |
Jan 2, 2018 | |
| Britney Session |
W-2 Managing Employee |
Jun 27, 2016 | |
| Kathleen Donham |
Corporate Director | Jan 1, 2026 | |
| John E Littleton |
Corporate Director | Jan 1, 2026 | |
| Jackson Baures |
Corporate Director | Jan 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040226000885 | OR | Part B Supplier - Clinic/Group Practice | 1557266236 |
Receives reassigned benefits from 47 practitioners 10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Medford, OR |
| O20170417000399 | OR | Part a Provider - Federally Qualified Health Center (FQHC) | 1557266236 | Practice locations: White City, OR |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | OR | Yes |
Addresses
Primary practice location
550 Wilson Way
White City, OR 97503-1351
Mailing address
550 Wilson Way
White City, OR 97503-1351
Phone (541) 830-6315
Other names
- White Mountain Health Center
Other providers in White City, OR
- Junlong Ren
- Korin Athena Richardson
- Alexsandra Rigg
- Jennifer Kira Riley
- Rogue Community Health
- Rogue Community Health
- Rogue Community Health
- Rogue Community Health
- Rogue RX Inc.
- Vivien Roman-Hampton
All providers in White City, OR · Federally Qualified Health Center (FQHC) in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.