NPIMap

Organization Active NPI

Grande Ronde Hospital, Inc

  • Rural Health Clinic/Center
  • Union, OR
National Provider Identifier
1780068080
Registry record updated Nov 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GRANDE RONDE HOSPITAL, INC
Practice address
142 E Dearborn
Union, OR 97883
Phone
(541) 963-1555
Fax
(541) 963-1845
NPI assigned
Jul 16, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2016

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

Authorized official

Name
Mr. James A Mattes
Title
President/Ceo
Phone
(541) 963-1464

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

142 E Dearborn
Union, OR 97883

Mailing address

PO Box 3290
La Grande, OR 97850-7290
Phone (541) 963-1555

Other names 1

  • GRANDE RONDE HOSPITAL UNION CLINIC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150909002653 OR Part A Provider - Rural Health Clinic 0547170789 Practice locations: Union, OR

Rural health clinic certification: CCN 388526

Legal name
GRANDE RONDE HOSPITAL INC
Doing business as
GRANDE RONDE HOSPITAL UNION CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 29, 2016
Last certification
Mar 30, 2016
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1986 in OR
Enrollment address
142 E Dearborn St
Union, OR 97883-9174
Related CCNs
381321

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Robert Fuller MD11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Stephen M McLean Individual Corporate OfficerBoard Member Jan 1, 2016
Grande Ronde Hospital Inc Organization, La Grande, OR Corporation, Non-profit 5% Or Greater Direct Ownership Interest Nov 1, 2005 100%
Samuel H Kimball Individual Corporate OfficerBoard Member Feb 22, 2017
Michael a Hetrick Individual Corporate OfficerBoard Member Jan 1, 2016
Suzanne D Hopper Individual Corporate OfficerBoard Member Jan 1, 2015
Blake a Gornowicz Individual Corporate OfficerBoard Member Jan 1, 2022
Robert P Seymour Individual Corporate OfficerCfo Nov 16, 2011
W-2 Managing EmployeeCfo Nov 16, 2011
Lara Kay Moore Individual Corporate OfficerBoard Member Nov 16, 2016
John Garlitz Individual Corporate OfficerBoard Member Jan 1, 2016
Nicholas Alvin Huelter Individual Corporate OfficerBoard Member Jan 1, 2021
Jeremy P Davis Individual Corporate OfficerCeo Nov 26, 2018
W-2 Managing EmployeeCeo Nov 26, 2018
Teri S Champlin Individual Corporate OfficerBoard Member Jan 1, 2014
Jared Cole Rogers Individual Corporate OfficerBoard Member Dec 24, 2019
Robert Coulter Individual Corporate OfficerBoard Member Jan 1, 2021
Michael E Billman Individual Corporate OfficerBoard Member Jan 1, 2019

Owners & managing parties with NPI records 10

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Grande Ronde Hospital IncLa Grande, OR, CCN 38Z321 Hospital Operational/Managerial Control May 31, 1966
Grande Ronde Hospital Regional Medical ClinicLa Grande, OR, CCN 388527 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2005
Grande Ronde Hospital Women'S & Children'S ClinicLa Grande, OR, CCN 388525 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1996
Grande Ronde Hospital Elgin ClinicElgin, OR, CCN 388524 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2005
Grande Ronde Hospital Urgent CareLa Grande, OR, CCN 388549 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 14, 2020

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 97

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

View all 97

NPI Registry JSON

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

{
    "created_epoch": "1437004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479686400000",
    "number": "1780068080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3290",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978507290",
            "telephone_number": "541-963-1555",
            "fax_number": "541-963-1845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 E DEARBORN",
            "city": "UNION",
            "state": "OR",
            "postal_code": "97883",
            "telephone_number": "541-963-1555",
            "fax_number": "541-963-1845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANDE RONDE HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-16",
        "last_updated": "2016-11-21",
        "status": "A",
        "authorized_official_last_name": "MATTES",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "541-963-1464",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRANDE RONDE HOSPITAL UNION CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Union, OR

Sources for this page

Verify at the official NPI Registry.