NPIMap

Organization Active NPI

Peacehealth Medical Group

  • Community/Retail Pharmacy
  • Springfield, OR
National Provider Identifier
1922018639
Registry record updated Sep 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHAO1124 Issued in AK
Legal business name
PEACEHEALTH MEDICAL GROUP
Practice address
3333 Riverbend Dr
Springfield, OR 97477-8800
Phone
(541) 222-5800
Fax
(541) 431-9149
NPI assigned
Aug 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2023

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

Authorized official

Name
Brennan Duane Black, PHARMD
Title
Pharmacy Manager/Pic
Phone
(541) 222-5800

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X RP-0000785-CS OR
Community/Retail Pharmacy 3336C0003X PHAO1124 AK Primary
Specialty Pharmacy 3336S0011X PHNR.FO.60259219 WA

Addresses

Primary practice location

3333 Riverbend Dr
Springfield, OR 97477-8800

Mailing address

3333 Riverbend Dr
Springfield, OR 97477-8800
Phone (541) 222-5800

Other identifiers 2

IdentifierTypeStateIssuer
053967MedicaidOR
2077299OtherPK

Other names 2

  • PEACEHEALTH EMPLOYEE PHARMACY Doing business as
  • PEACEHEALTH RIVERBEND OUTPATIENT PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Peacehealth Medical Group11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694390400000",
    "number": "1922018639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 RIVERBEND DR",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974778800",
            "telephone_number": "541-222-5800",
            "fax_number": "541-431-9149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 RIVERBEND DR",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974778800",
            "telephone_number": "541-222-5800",
            "fax_number": "541-431-9149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACEHEALTH MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-11",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "BRENNAN",
        "authorized_official_middle_name": "DUANE",
        "authorized_official_title_or_position": "PHARMACY MANAGER/PIC",
        "authorized_official_telephone_number": "541-222-5800",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "OR",
            "license": "RP-0000785-CS",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AK",
            "license": "PHAO1124",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "WA",
            "license": "PHNR.FO.60259219",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "053967",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2077299",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PEACEHEALTH EMPLOYEE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PEACEHEALTH RIVERBEND OUTPATIENT PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.