NPIMap

Organization Active NPI

Good Shepherd Health Care System

  • Home Health Agency
  • Hermiston, OR
National Provider Identifier
1902849375
Registry record updated May 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
GOOD SHEPHERD HEALTH CARE SYSTEM
Practice address
610 NW 11TH St
Hermiston, OR 97838
Phone
(541) 667-3400
NPI assigned
Jun 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2021

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

Authorized official

Name
Jonathan Edwards
Title
Finance Director
Phone
(541) 667-3438

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X OR Primary

Addresses

Primary practice location

610 NW 11TH St
Hermiston, OR 97838

Mailing address

610 NW 11TH St
Hermiston, OR 97838
Phone (541) 667-3400

Other identifiers 2

IdentifierTypeStateIssuer
047258MedicaidOR
1380023OtherORBLUE CROSS

Other names 1

  • Good Shepherd Home Health Agency Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050705000509 OR Part A Provider - Home Health Agency 9133033764 Practice locations: Hermiston, OR

Home health agency certification: CCN 387090

Legal name
GOOD SHEPHERD HEALTH CARE SYSTEM
Doing business as
GOOD SHEPHERD HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Feb 12, 1986
Last certification
Mar 20, 2019
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
May 8, 1953 in OR
Enrollment address
645 W Orchard Ave
Ste 500
Hermiston, OR 97838-1692

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Good Shepherd Home HealthCCN 387090
Overall star rating
2.5 of 5
Ownership
Non-Profit
Certified
Feb 12, 1986
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2061717Good Shepherd Home Health645 W Orchard Ave Suite 500, Hermiston, OR 97838Certificate of waiverJul 1, 2027

National Provider Directory

National Provider Directory
Tax ID family
Good Shepherd Medical G7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

620 NW 11th St
Ste M103
Hermiston, OR 97838
Phone (541) 667-3830

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
Jaclyn Jenkins Individual Corporate DirectorBoard Member Oct 23, 2023
Robert Longoria Individual Corporate DirectorBoard Member Oct 23, 2023
Carl Carlson Individual Corporate DirectorBoard Member Jan 1, 2009
Thomas Wamsley Individual Corporate DirectorBoard Member Jan 1, 2009
Arthur Mathisen Individual Corporate OfficerPresident/Ceo Jul 24, 2023 100%
Brian Patrick Individual W-2 Managing EmployeeVP of Nursing Sep 8, 2020
Susan Daggett Individual Corporate DirectorBoard Member Jan 1, 2009
Arnell Eynon Individual Corporate DirectorBoard Member Mar 1, 2016
Jon Lorence Individual Corporate DirectorBoard Member Oct 22, 2018
Nancy Mabry Individual Corporate DirectorBoard Member Jan 1, 2009
Jonathan Edwards Individual Contracted Managing EmployeeCoo/Cfo Apr 7, 2008
Corporate OfficerCoo/Cfo Apr 7, 2008
Corporate DirectorCoo/Cfo Apr 7, 2008
Lisa Mittelsdorf Individual Corporate DirectorBoard Member Oct 28, 2019
Merle Steven Eldrige Individual Corporate DirectorBoard Member Jan 1, 2009
Derek T. Earl Individual Corporate DirectorBoard Member Jan 1, 2009
Kristen Coller Individual Corporate DirectorBoard Member Oct 24, 2022

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 128

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

View all 128

Affiliated clinicians 42

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620864000000",
    "number": "1902849375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 NW 11TH ST",
            "city": "HERMISTON",
            "state": "OR",
            "postal_code": "97838",
            "telephone_number": "541-667-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 NW 11TH ST",
            "city": "HERMISTON",
            "state": "OR",
            "postal_code": "97838",
            "telephone_number": "541-667-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD HEALTH CARE SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "FINANCE DIRECTOR",
        "authorized_official_telephone_number": "541-667-3438"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "047258",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "1380023",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Good Shepherd Home Health Agency",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hermiston, OR

Sources for this page

Verify at the official NPI Registry.