NPIMap

Organization Active NPI

Clackamas County

Doing business as Sandy Behavioral Health Center

  • Federally Qualified Health Center (FQHC)
  • Sandy, OR
National Provider Identifier
1841442001
Registry record updated Dec 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CLACKAMAS COUNTY
Doing business as
Sandy Behavioral Health Center
Sandy Behavioral Health Clinic
Practice address
39740 Pleasant St
Sandy, OR 97055-6412
Phone
(503) 722-6937
Fax
(503) 722-6850
NPI assigned
Oct 21, 2008
Last updated
Dec 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2022

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

Authorized official

Name
Sarah Jacobson
Title
Director - Interim
Phone
(503) 201-1890

Specialties & licenses 1

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

Addresses

Primary practice location

39740 Pleasant St
Sandy, OR 97055-6412

Mailing address

2051 Kaen Rd
Suite 367
Oregon City, OR 97045-4035
Phone (503) 742-5300

Other names 2

  • Sandy Behavioral Health Center Doing business as
  • Sandy Behavioral Health Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040602000311 OR Part A Provider - Federally Qualified Health Center (FQHC) 9537065560 1 other NPI on this enrollment
Practice locations: Sandy, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841442001. Details of each certification follow.

Federally qualified health center certification: CCN 381870

Legal name
COUNTY OF CLACKAMAS OFFICE OF COUNTY AUDITOR
Doing business as
CLACKAMAS HEALTH CENTERS - SANDY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 14, 2004
Last certification
Jun 14, 2004
Ownership / control type
Non-profit – corporation
Organization structure
GovernmentNon-profit
Incorporated
Jan 1, 1966 in OR
Enrollment address
39740 Pleasant St
Sandy, OR 97055-6412

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Clackamas County Public15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Morgan Fetzer Individual W-2 Managing EmployeeAdministrative Assistant Mar 1, 2015
Sarah Jacobson Individual W-2 Managing EmployeeOffice Manager Fiscal Dec 1, 2014 100%
County of Clackamas Office of County Auditor Organization, Sandy, OR Non-profit Operational/Managerial Control Dec 13, 2010
Adam Kearl Individual W-2 Managing EmployeeAd; Aug 1, 2018

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Clackamas Health CentersOregon City, OR, CCN 381820 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2014
Jan 1, 2014
Clackamas Health CentersGladstone, OR, CCN 381923 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2014
Sep 1, 2010
Lake Road Health CenterMilwaukie, OR, CCN 381922 Federally qualified health center Operational/Managerial Control (100%) Aug 28, 2006
Clackamas Health CentersClackamas, OR, CCN 381931 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2014
Jan 1, 2014
Clackamas Health Centers - Sandy Health ClinicSandy, OR, CCN 381936 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2014
Jan 28, 2013
Clackamas Health CentersOregon City, OR, CCN 381944 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 1990
Jan 1, 1990

Owned or controlled facilities with NPI records 6

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

  • Clackamas County

    dba Clackamas Health Centers - 1011 Courthouse Road

    • Federally Qualified Health Center (FQHC)
    • Oregon City, OR
    • NPI 1447507215

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Clackamas County

    dba Beavercreek Health Clinic

    • Federally Qualified Health Center (FQHC)
    • Oregon City, OR
    • NPI 1720017809

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Clackamas County

    dba Sunnyside Health Clinic

    • Federally Qualified Health Center (FQHC)
    • Clackamas, OR
    • NPI 1891042487

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • County of Clackamas Office of County Auditor

    dba Sandy Health Clinic

    • Federally Qualified Health Center (FQHC)
    • Sandy, OR
    • NPI 1043566847

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • County of Clackamas Office of County Auditor

    dba Hilltop Behavioral Health Center

    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Milwaukie, OR
    • NPI 1245269315

    Operational/Managerial Control

    CMS ownership
  • County of Clackamas Office of County Auditor

    dba Gladstone Health Clinic

    • Federally Qualified Health Center (FQHC)
    • Gladstone, OR
    • NPI 1275880866

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 6

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

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1224547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669852800000",
    "number": "1841442001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2051 KAEN RD",
            "address_2": "SUITE 367",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970454035",
            "telephone_number": "503-742-5300",
            "fax_number": "503-655-8350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39740 PLEASANT ST",
            "city": "SANDY",
            "state": "OR",
            "postal_code": "970556412",
            "telephone_number": "503-722-6937",
            "fax_number": "503-722-6850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLACKAMAS COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-21",
        "last_updated": "2022-12-01",
        "certification_date": "2022-12-01",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "DIRECTOR - INTERIM",
        "authorized_official_telephone_number": "503-201-1890"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sandy Behavioral Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sandy Behavioral Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sandy, OR

Sources for this page

Verify at the official NPI Registry.