NPIMap

Organization Active NPI

County of Crook

  • Federal Public Health Clinic/Center
  • Prineville, OR
National Provider Identifier
1841304920
Registry record updated Jul 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federal Public Health Clinic/CenterTaxonomy code 261QP0904X
License
MD19870 Issued in OR
Legal business name
COUNTY OF CROOK
Practice address
375 NW Beaver St
Suite 100
Prineville, OR 97754
Phone
(541) 447-5165
Fax
(541) 477-3093
NPI assigned
Aug 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2007

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

Authorized official

Name
Holly Jo Ledgerwood Hodges, MD
Title
Health Officer
Phone
(541) 477-6263

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Ambulatory Family Planning Facility 261QA0005X
Federal Public Health Clinic/Center 261QP0904X MD19870 OR Primary
State or Local Public Health Clinic/Center 261QP0905X MD19870 OR

Addresses

Primary practice location

375 NW Beaver St
Suite 100
Prineville, OR 97754

Mailing address

375 NW Beaver St
Suite 100
Prineville, OR 97754
Phone (541) 447-5165

Other identifiers 3

IdentifierTypeStateIssuer
043005MedicaidOR
054494MedicaidOR
320317MedicaidOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040809000213 OR Part B Supplier - Mass Immunization (Roster Biller Only) 5991777211 Practice locations: Prineville, OR

National Provider Directory

National Provider Directory
Tax ID family
County of Crook3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185494400000",
    "number": "1841304920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 NW BEAVER ST",
            "address_2": "SUITE 100",
            "city": "PRINEVILLE",
            "state": "OR",
            "postal_code": "97754",
            "telephone_number": "541-447-5165",
            "fax_number": "541-477-3093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 NW BEAVER ST",
            "address_2": "SUITE 100",
            "city": "PRINEVILLE",
            "state": "OR",
            "postal_code": "97754",
            "telephone_number": "541-447-5165",
            "fax_number": "541-477-3093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF CROOK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2007-07-27",
        "status": "A",
        "authorized_official_last_name": "HODGES",
        "authorized_official_first_name": "HOLLY JO",
        "authorized_official_middle_name": "LEDGERWOOD",
        "authorized_official_title_or_position": "HEALTH OFFICER",
        "authorized_official_telephone_number": "541-477-6263",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA0005X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Family Planning Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP0904X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, Federal",
            "state": "OR",
            "license": "MD19870",
            "primary": true
        },
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": "OR",
            "license": "MD19870",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "043005",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "054494",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "320317",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Prineville, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2007; 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.