Providence Health & Services - Oregon

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PROVIDENCE HEALTH & SERVICES - OREGON

Doing business as

Providence Medical Group
Providence Hood River ENT

Practice address

1619 Woods CT
Hood River, OR 97031-2915

Phone

(541) 386-5119

Fax

(541) 386-3061

NPI assigned

Sep 18, 2012

Last updated

Jul 4, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Donald W Anderson Jr.

Title

Assistant Secretary Enrollment

Phone

(425) 358-9786

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 2

• PROVIDENCE MEDICAL GROUP Doing business as
• Providence Hood River ENT Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Practitioners 5

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.

• Jay Ham, MD

  • Hospitalist Physician
  • Newberg, OR
  • NPI 1760659627
  NPD
• Jenna E Kay, M.D.

  • Advanced Heart Failure and Transplant Cardiology Physician
  • Portland, OR
  • NPI 1760771380
  NPD
• Suzanne McKenzie

  • Speech-Language Pathologist
  • Portland, OR
  • NPI 1063967628
  NPD
• Pavel Mitaru, DO

  • Family Medicine Physician
  • Portland, OR
  • NPI 1760862494
  NPD
• Sheri Beth Prom, DPT

  • Physical Therapist
  • Corvallis, OR
  • NPI 1386996999
  NPD

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

{
    "created_epoch": "1347926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751587200000",
    "number": "1750631784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001 - 4180",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1619 WOODS CT",
            "city": "HOOD RIVER",
            "state": "OR",
            "postal_code": "970312915",
            "telephone_number": "541-386-5119",
            "fax_number": "541-386-3061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-18",
        "last_updated": "2025-07-04",
        "certification_date": "2025-07-04",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500650973",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Hood River ENT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marleigh Poulsen
• Keeya Prairie, PSYD
• Kevin Prates, D.D.S.
• Sarah J Prates, PHARMD
• Randolph E Price
• Providence Health & Services Oregon (Providence Hood River Memorial Hospital)
• Providence Health & Services Oregon (Providence Hood River Memorial Hospital - Rural Health Clinic)
• Providence Health & Services Oregon (Providence Hood River Memorial Hospital)
• Providence Health & Services Oregon (Providence Hood River Memorial Hospital)
• Providence Health & Services Oregon (Providence Hospice of the Gorge)

• Clinic/Center in Hood River, OR
• Providers in Hood River, OR by specialty
• Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2025; 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.