NPIMap

Organization Active NPI

Rogue Community Health

  • Federally Qualified Health Center (FQHC)
  • White City, OR
National Provider Identifier
1770645871
Registry record updated Oct 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ROGUE COMMUNITY HEALTH
Practice address
8385 Division Road
White City, OR 97503-1176
Phone
(541) 826-5853
Fax
(541) 826-5843
NPI assigned
Dec 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2020

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

Authorized official

Name
Calisa N Warnke
Title
Cfo
Phone
(541) 842-7642

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

8385 Division Road
White City, OR 97503-1176

Mailing address

8385 Division Road
White City, OR 97503-1176
Phone (541) 826-5853

Other identifiers 1

IdentifierTypeStateIssuer
227698MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031220000023 OR Part A Provider - Federally Qualified Health Center (FQHC) 1557266236 Practice locations: White City, OR
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

Federally qualified health center certification: CCN 381859

Legal name
ROGUE COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 5, 2004
Last certification
Feb 5, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 20, 1974 in OR
Enrollment address
8385 Division Rd
White City, OR 97503-1176

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Nancy S Nordyke Individual Corporate Director Sep 1, 2020
Tom D Hazel Individual Corporate Director Apr 25, 2019
Mary Coombs Individual Corporate Director May 24, 2018
Nate Sickler Individual Corporate Director Oct 24, 2019
David Figurate Individual Corporate DirectorDirector Aug 25, 2016
Doug D McKenzie Individual Corporate DirectorSecretary Feb 27, 2014
Julia Ellen Benezet Individual Corporate Director Mar 1, 2021
Calisa Noorda Warnke Individual Corporate OfficerCfo Jan 2, 2018
Britney Session Individual Corporate DirectorSenior Director of Finance Jun 27, 2016
W-2 Managing Employee Jun 27, 2016
William North Individual Corporate OfficerCeo Jan 22, 2014
Catherine Gillooly Individual Corporate DirectorCommunity Advocate Jan 28, 2016
Tina Mondale Individual Corporate Director Oct 1, 2020
Jackson Baures Individual Corporate Director Oct 24, 2019

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 6

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

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602720000000",
    "number": "1770645871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8385 DIVISION ROAD",
            "city": "WHITE CITY",
            "state": "OR",
            "postal_code": "975031176",
            "telephone_number": "541-826-5853",
            "fax_number": "541-826-5843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8385 DIVISION ROAD",
            "city": "WHITE CITY",
            "state": "OR",
            "postal_code": "975031176",
            "telephone_number": "541-826-5853",
            "fax_number": "541-826-5843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGUE COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A",
        "authorized_official_last_name": "WARNKE",
        "authorized_official_first_name": "CALISA",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "541-842-7642"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "227698",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in White City, OR

Sources for this page

Verify at the official NPI Registry.