NPIMap

Organization Active NPI

Rogue Community Health

  • Federally Qualified Health Center (FQHC)
  • White City, OR
National Provider Identifier
1912450461
Registry record updated Oct 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ROGUE COMMUNITY HEALTH
Practice address
2830 Maple CT
White City, OR 97503-1357
Phone
(541) 830-1350
Fax
(541) 830-6566
NPI assigned
Aug 2, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2023

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

Authorized official

Name
Calisa N Warnke
Title
Cfo
Phone
(541) 842-7642

Specialties & licenses 1

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

Addresses

Primary practice location

2830 Maple CT
White City, OR 97503-1357

Mailing address

2830 Maple CT
White City, OR 97503-1357
Phone (541) 830-1350

Other names 1

  • Table Rock Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040226000885 OR Part B Supplier - Clinic/Group Practice 1557266236 Receives reassigned benefits from 47 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Medford, OR
O20170410002538 OR Part A Provider - Federally Qualified Health Center (FQHC) 1557266236 Practice locations: White City, OR

Federally qualified health center certification: CCN 381975

Legal name
ROGUE COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 20, 2017
Last certification
Feb 20, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 20, 1974 in OR
Enrollment address
2830 Maple CT
White City, OR 97503-1357

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory

Ownership & related parties

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.

NameRoleSinceShare
Nancy S Nordyke Individual Corporate Director Jan 1, 2023
Johnathan Caldwell Individual Corporate Director Jan 1, 2023
John F. Mytinger Individual Corporate DirectorBoard Treasurer Jul 1, 2015
Operational/Managerial Control Apr 12, 2017
Nate Sickler Individual Corporate Director Jan 1, 2023
Martha Miller Individual Corporate Director Jan 1, 2023
Doug D McKenzie Individual Corporate DirectorBoard President Feb 27, 2014
Stick Crosby Individual Corporate Officer Jan 1, 2025
Calisa Noorda Warnke Individual Corporate OfficerCeo Jan 2, 2018
Britney Session Individual W-2 Managing EmployeeCfo Jun 27, 2016
Kathleen Donham Individual Corporate Officer Jan 1, 2025
Jackson Baures Individual Corporate Director Jan 1, 2023

NPI Registry JSON

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

{
    "created_epoch": "1470096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698710400000",
    "number": "1912450461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2830 MAPLE CT",
            "city": "WHITE CITY",
            "state": "OR",
            "postal_code": "975031357",
            "telephone_number": "541-830-1350",
            "fax_number": "541-830-6566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2830 MAPLE CT",
            "city": "WHITE CITY",
            "state": "OR",
            "postal_code": "975031357",
            "telephone_number": "541-830-1350",
            "fax_number": "541-830-6566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGUE COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-02",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A",
        "authorized_official_last_name": "WARNKE",
        "authorized_official_first_name": "CALISA",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "541-842-7642"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Table Rock Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in White City, OR

Sources for this page

Verify at the official NPI Registry.