NPIMap

Organization Active NPI

North Bend Medical Center Inc

  • Clinical Medical Laboratory
  • Coos Bay, OR
National Provider Identifier
1760404396
Registry record updated Dec 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
38DO627047 Issued in OR
Legal business name
NORTH BEND MEDICAL CENTER INC
Practice address
1900 Woodland Dr
Coos Bay, OR 97420-0000
Phone
(541) 267-5151
Fax
(541) 266-4501
NPI assigned
Jul 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2023

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

Authorized official

Name
Steven A Tersigni, MDNPI 1649256892
Title
Interim Ceo
Phone
(541) 267-5151

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 38DO627047 OR Primary

Addresses

Primary practice location

1900 Woodland Dr
Coos Bay, OR 97420-0000

Mailing address

1900 Woodland Dr
Coos Bay, OR 97420-0000
Phone (541) 267-5151

Other identifiers 6

IdentifierTypeStateIssuer
690001817OtherORRR MED GROUP PTAN NUMBER
1407812365OtherORNBMC GROUP NPI NUMBER
R0000WBGKXOtherORMEDICARE GROUP PIN NUMBER
133897MedicaidOR
38DO627047OtherORCLIA NUMBER
500400245MedicaidOR

Other names 1

  • NBMC-LABORATORY Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040305000886 OR Part B Supplier - Independent Clinical Laboratory 5597677716 Practice locations: Coos Bay, OR

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D0627047North Bend Medical Center1900 Woodland Drive, Coos Bay, OR 97420ComplianceOct 8, 2027
38D0937421North Bend Medical Physicians1900 Woodland Drive, Coos Bay, OR 97420Provider-performed microscopySep 14, 2027

National Provider Directory

National Provider Directory
Tax ID family
North Bend Med Ctr Radi2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701907200000",
    "number": "1760404396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 WOODLAND DR",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974200000",
            "telephone_number": "541-267-5151",
            "fax_number": "541-266-4501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 WOODLAND DR",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974200000",
            "telephone_number": "541-267-5151",
            "fax_number": "541-266-4501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH BEND MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-24",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-07",
        "status": "A",
        "authorized_official_last_name": "TERSIGNI",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "INTERIM CEO",
        "authorized_official_telephone_number": "541-267-5151",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "OR",
            "license": "38DO627047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MED GROUP PTAN NUMBER",
            "identifier": "690001817",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NBMC GROUP NPI NUMBER",
            "identifier": "1407812365",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PIN NUMBER",
            "identifier": "R0000WBGKX",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "133897",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA NUMBER",
            "identifier": "38DO627047",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500400245",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NBMC-LABORATORY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NBMC-LABORATORY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coos Bay, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.