Adapt

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

ADAPT

Practice address

621 W Madrone St
Roseburg, OR 97470-3090

Phone

(541) 492-4550

Fax

(541) 492-4553

NPI assigned

Oct 9, 2018

Last updated

Apr 12, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

ADAPTAs reported in NPPES

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

Authorized official

Name

Michelle Monet Watson

Title

Chief Operations Officer

Phone

(541) 492-4550

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861967648. Details of each certification follow.

• CCN 381003 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 381003

Legal name

ADAPT

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jun 2, 2022

Last certification

Jun 2, 2022

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Jun 1, 1971 in OR

Enrollment address

621 W Madrone St
Roseburg, OR 97470-3090

Other NPIs with the same Medicare PAC ID 6

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

• Adapt

  dba Adapt Integrated Health Care

  • Federally Qualified Health Center (FQHC)
  • Roseburg, OR
  • NPI 1184350811

  4587662887

  Same PAC ID
• Adapt

  dba Adapt Integrated Health Care

  • Federally Qualified Health Center (FQHC)
  • Bandon, OR
  • NPI 1194529289

  4587662887

  Same PAC ID
• Adapt

  dba North Bend OTP

  • Addiction (Substance Use Disorder) Counselor
  • North Bend, OR
  • NPI 1497248025

  4587662887

  Same PAC ID
• Adapt

  • Addiction (Substance Use Disorder) Counselor
  • Roseburg, OR
  • NPI 1720010549

  4587662887

  Same PAC ID
• Adapt

  • Federally Qualified Health Center (FQHC)
  • Roseburg, OR
  • NPI 1750975553

  4587662887

  Same PAC ID
• Adapt

  dba SouthRiver Medical Clinic aka: SouthRiver Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Winston, OR
  • NPI 1912061755

  4587662887

  Same PAC ID

Other NPIs on the same Medicare enrollment 9

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

• Adapt

  • Addiction (Substance Use Disorder) Counselor
  • North Bend, OR
  • NPI 1154502052

  O20061121000327

  Same enrollment
• Adapt

  dba Adapt Integrated Health Care

  • Federally Qualified Health Center (FQHC)
  • Roseburg, OR
  • NPI 1184350811

  O20061121000327

  Same enrollment
• Adapt

  dba Adapt Integrated Health Care

  • Federally Qualified Health Center (FQHC)
  • Bandon, OR
  • NPI 1194529289

  O20061121000327

  Same enrollment
• Adapt

  dba Compass Behavioral Health

  • Community/Behavioral Health Agency
  • Roseburg, OR
  • NPI 1639682883

  O20061121000327

  Same enrollment
• Adapt

  • Substance Abuse Rehabilitation Facility
  • Roseburg, OR
  • NPI 1649453440

  O20061121000327

  Same enrollment
• Adapt

  • Addiction (Substance Use Disorder) Counselor
  • Roseburg, OR
  • NPI 1720010549

  O20061121000327

  Same enrollment
• Adapt

  • Children's Substance Abuse Rehabilitation Facility
  • Roseburg, OR
  • NPI 1730362534

  O20061121000327

  Same enrollment
• Adapt

  dba Adapt Integrated Health Care

  • Community/Behavioral Health Agency
  • Brookings, OR
  • NPI 1760145338

  O20061121000327

  Same enrollment
• Adapt

  dba SouthRiver Medical Clinic aka: SouthRiver Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Winston, OR
  • NPI 1912061755

  O20061121000327

  Same enrollment

Part of

Adapt

Locations

All disclosed owners & managing parties 11

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

All facility ownership & control disclosures 1

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

Owned or controlled facilities with NPI records 1

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

• Adapt

  dba SouthRiver Medical Clinic aka: SouthRiver Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Winston, OR
  • NPI 1912061755

  Operational/Managerial Control

  CMS ownership

Practitioners 17

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.

• Laurance Walter Choate, M.D.

  • Family Medicine Physician
  • Roseburg, OR
  • NPI 1598737033
  NPD
• Jayson Clark, MSMFT, LPC

  • Professional Counselor
  • Roseburg, OR
  • NPI 1598198954
  NPD
• Susan Ellis, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Roseburg, OR
  • NPI 1750706800
  NPD
• Mary Christine Garwood, FNP

  • Family Nurse Practitioner
  • Roseburg, OR
  • NPI 1437668282
  NPD
• Jennie L Gohman, NP

  • Gerontology Nurse Practitioner
  • Winston, OR
  • NPI 1417614611
  NPD
• Erica Ishmael

  • Professional Counselor
  • Roseburg, OR
  • NPI 1992161814
  NPD
• Tisha Marie Larsen

  • Adult Psychiatric/Mental Health Registered Nurse
  • Roseburg, OR
  • NPI 1578954855
  NPD
• Kira Kristina Lathrop, MA, LPC, DBTC

  • Professional Counselor
  • Roseburg, OR
  • NPI 1609223809
  NPD
• Thaen Chiam Saelee, PSY.D

  • Clinical Psychologist
  • Roseburg, OR
  • NPI 1831388461
  NPD
• Rebekah Anne Tripp

  • Clinical Social Worker
  • Roseburg, OR
  • NPI 1720735277
  NPD
• Christina Marie Brakebill, RN, FNP-BC

  • Family Nurse Practitioner
  • Bandon, OR
  • NPI 1992133607
  NPD (past)
• Beatrice Mupenzi May

  • Psychiatric/Mental Health Nurse Practitioner
  • Roseburg, OR
  • NPI 1881197804
  NPD (past)

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

{
    "created_epoch": "1539043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649721600000",
    "number": "1861967648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1121",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974700254",
            "telephone_number": "541-492-4550",
            "fax_number": "541-492-0190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 W MADRONE ST",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974703090",
            "telephone_number": "541-492-4550",
            "fax_number": "541-492-4553"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "671 SW Main St",
            "address_purpose": "LOCATION",
            "city": "Winston",
            "state": "OR",
            "postal_code": "974966571",
            "country_code": "US",
            "telephone_number": "541-492-4550",
            "fax_number": "541-492-4553",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ADAPT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADAPT",
        "enumeration_date": "2018-10-09",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "MONET",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "541-492-4550"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adapt
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• Adapt
• Adapt
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• Federally Qualified Health Center (FQHC) in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Federally Qualified Health Center (FQHC) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.