Clackamas County
Organization Active NPI Federally Qualified Health Center (FQHC) · Sandy, OR
NPI 1841442001 · NPPES record last updated Dec 1, 2022
Key facts
- NPI
- 1841442001
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- CLACKAMAS COUNTY
- Practice address
- 39740 Pleasant St
Sandy, OR 97055-6412 - Phone
- (503) 722-6937
- Fax
- (503) 722-6850
- NPI assigned
- Oct 21, 2008
- Organization subpart
- No
Authorized official
- Name
- Sarah Jacobson
- Title
- Director - Interim
- Phone
- (503) 201-1890
Owners & managing parties with NPI records 7
Owned or controlled facilities with NPI records 6
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 14
Facilities with the same owner 6
Practitioners 93
-
Karen G Hedden, PMHNP
-
Candia Marie Hills, LCSW, CADCI
-
Oana Mihaela Pieretti, MA, MFT
-
Christopher J Robb, LCSW
-
Angela Amundson, FNP
-
Jonathan P Ayers, LCSW
-
Matthew P Azar, LCSW
-
Navaz Behramkamdin, MA, LPC
-
Brian Bizub, MD
-
Kristin Brittany Brown, LCSW, CADC II
-
Kelly Pamela Caceres, LPC
-
Karen Carpenter, LCSW
-
Robert Duffy, D.O.
-
Heidi Feight, LCSW
-
Anya Glenn, MA, QMHP
-
Andrea L Gore, CDP
-
Stephanie Gregory, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
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
- Government · Non-profit
- Incorporated
- Jan 1, 1966 in OR
- Enrollment address
- 39740 Pleasant St
Sandy, OR 97055-6412
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Morgan Fetzer |
W-2 Managing Employee |
Mar 1, 2015 | |
| Sarah Jacobson |
W-2 Managing Employee |
Dec 1, 2014 | 100% |
| County of Clackamas Office of County Auditor |
Operational/Managerial Control | Dec 13, 2010 | |
| Adam Kearl |
W-2 Managing Employee |
Aug 1, 2018 |
All facility ownership & control disclosures 6
| Facility | Type | Role | Since |
|---|---|---|---|
| Clackamas Health Centers |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 1, 2014 Jan 1, 2014 |
| Clackamas Health Centers |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 1, 2014 Sep 1, 2010 |
| Lake Road Health Center |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 28, 2006 |
| Clackamas Health Centers |
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 Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 1, 2014 Jan 28, 2013 |
| Clackamas Health Centers |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 1, 1990 Jan 1, 1990 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040602000311 | OR | Part a Provider - Federally Qualified Health Center (FQHC) | 9537065560 |
1 other NPI on this enrollment Practice locations: Sandy, OR |
National Provider Directory
- Tax ID family
- Clackamas County Mental
Locations
38872 Proctor Blvd
Sandy, OR 97055
Phone (503) 722-6950
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 022710 | Medicaid | OR |
Other names
- Sandy Behavioral Health Center
- Sandy Behavioral Health Clinic
Other providers in Sandy, OR
- Carl E. Swarts
- Cascade Specialized Nursing, LLC.
- Catherine Saul, OD, LLC
- Michael J Cha
- Chinook Falls Dental Clinic, PC
- Ethan Yoshio Claggett
- Kenneth George Claggett
- Carrie Renee Conklin
- Derek Conklin
- Cynthia Lynn Conlin
All providers in Sandy, OR · Federally Qualified Health Center (FQHC) in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.