NPIMap

Organization Active NPI

Central City Concern, Inc.

Doing business as Blackburn Center

  • Federally Qualified Health Center (FQHC)
  • Portland, OR
National Provider Identifier
1932674801
Registry record updated Apr 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTRAL CITY CONCERN, INC.
Doing business as
Blackburn Center
Practice address
12121 E Burnside St
Portland, OR 97216-3737
Phone
(971) 361-7700
NPI assigned
Oct 8, 2018
Last updated
Apr 9, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2026

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

Authorized official

Name
Dr. Andrew Mendenhall, MDNPI 1053347591
Title
President & Ceo
Phone
(503) 294-1681

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

12121 E Burnside St
Portland, OR 97216-3737

Mailing address

121 NW Everett St
Portland, OR 97209-4049
Phone (503) 501-5641

Other names 1

  • Blackburn Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190116001366 OR Part A Provider - Federally Qualified Health Center (FQHC) 6103803259 1 other NPI on this enrollment
Practice locations: Portland, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932674801. Details of each certification follow.

Federally qualified health center certification: CCN 931001

Legal name
CENTRAL CITY CONCERN, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 27, 2019
Last certification
Jun 27, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 12, 1978 in OR
Enrollment address
12121 E Burnside St
Portland, OR 97216-3737

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Central City Concern Inc18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Jonathan Radmacher Individual Corporate OfficerBoard Chair Jul 1, 2021
Corporate DirectorBoard Member Oct 20, 2010
Elisabeth Zeller Individual Corporate OfficerBoard Chair Jul 1, 2021
Corporate DirectorBoard Member Feb 18, 2016
Ann Remmers Individual Corporate DirectorBoard Member Jan 15, 2025
David Swartley Individual Corporate DirectorBoard Member Aug 18, 2021
Fernando Pena Individual Corporate OfficerBoard Secretary/Treasurer Apr 19, 2023
Corporate DirectorBoard Secretary/Treasurer Apr 19, 2023
Carrie Smith Individual Corporate Director Mar 15, 2023
Andrew B Mendenhall Individual Corporate OfficerPresident & Ceo Jul 1, 2022
W-2 Managing EmployeePresident & Ceo Jul 1, 2022
Peter Beyer Individual Corporate OfficerChief Financial Officer Sep 7, 2021
Corporate DirectorChief Financial Officer Sep 7, 2021
W-2 Managing EmployeeChief Financial Officer Sep 7, 2021
Operational/Managerial ControlChief Financial Officer Sep 7, 2021
Jenny Kim Individual Corporate DirectorBoard Member Aug 20, 2025
Mamie Gathard Individual Corporate DirectorBoard Member Jul 1, 2023
Katrina McPherson Individual Corporate DirectorBoard Member Feb 17, 2023
David Chen Individual Corporate OfficerGeneral Counsel Jul 6, 2021
W-2 Managing EmployeeGeneral Counsel Jul 6, 2021
Operational/Managerial ControlGeneral Counsel Jul 6, 2021
Phyusin Myint Individual Corporate DirectorBoard Member Aug 20, 2025
William Rasmussen Individual Corporate DirectorBoard Member Aug 20, 2025
Eric Fishman Individual Corporate DirectorBoard Member May 18, 2022
Stacie L Carney Individual Corporate DirectorBoard Member Oct 16, 2024
Rilla Delorier Individual Corporate OfficerBoard Vice Chair Jul 1, 2023
Corporate DirectorBoard Member Nov 26, 2018
Caresse Sakagawa Individual Corporate DirectorBoard Member Sep 20, 2023
Marguerita Lightfoot Individual Corporate DirectorBoard Member Nov 20, 2024

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1538956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775692800000",
    "number": "1932674801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 NW EVERETT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972094049",
            "telephone_number": "503-501-5641",
            "fax_number": "503-294-4321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12121 E BURNSIDE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972163737",
            "telephone_number": "971-361-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL CITY CONCERN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-08",
        "last_updated": "2026-04-09",
        "certification_date": "2026-04-09",
        "status": "A",
        "authorized_official_last_name": "MENDENHALL",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "503-294-1681",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blackburn Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.