NPIMap

Organization Active NPI

Praxis Health, PC

  • Rural Health Clinic/Center
  • Dallas, OR
National Provider Identifier
1942925326
Registry record updated Oct 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PRAXIS HEALTH, PC
Practice address
531 SE Clay St
Dallas, OR 97338-2865
Phone
(971) 612-6100
Fax
(971) 612-6101
NPI assigned
Oct 7, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2022

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

Authorized official

Name
Jessica M Reagan
Title
Revenue Cycle Director
Phone
(541) 966-6136

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

531 SE Clay St
Dallas, OR 97338-2865

Mailing address

PO Box 1517
Pendleton, OR 97801-0410
Phone (877) 708-1119

Other names 1

  • Dallas Family Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221027001656 OR Part A Provider - Rural Health Clinic 8325941446 Practice locations: Dallas, OR

Rural health clinic certification: CCN 383918

Legal name
PRAXIS HEALTH PC
Doing business as
DALLAS FAMILY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 21, 2023
Last certification
Dec 21, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationProprietary
Incorporated
Nov 5, 1996 in OR
Enrollment address
531 SE Clay St
Dallas, OR 97338-2865

Other NPIs with the same Medicare PAC ID 4

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

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
38D2232173Dallas Family Care531 SE Clay St, Dallas, OR 97338Certificate of waiverAug 9, 2027

National Provider Directory

National Provider Directory
Tax ID family
Praxis Medical Group Inc7 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

1247 NE Medical Center Dr
Ste C
Bend, OR 97701
Phone (541) 318-4249

18 NW Oregon Ave
Bend, OR 97703
Phone (541) 318-4249

71 E 15th Ave
Eugene, OR 97401
Phone (541) 431-0000

1001 Molalla Ave
Ste 100
Oregon City, OR 97045
Phone (503) 656-5273

236 NW Kingwood Ave
Redmond, OR 97756
Phone (541) 504-4603

13240 SW Pacific Hwy
Ste C
Tigard, OR 97223
Phone (503) 598-2008

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
McKenzie C Kennedy Individual Corporate OfficerRegional Administrator Jul 1, 2016
W-2 Managing EmployeeRegional Administrator Jul 1, 2016
Garrett Kennedy Individual Corporate OfficerCeo Jan 1, 2016
Corporate DirectorSecretary/Director Jan 1, 2009
Stephen a Mann Individual Corporate DirectorPresident/Director Jan 1, 2009
Adaugeo Healthcare Solutions LLC Organization, Pendleton, OR LLC 5% Or Greater Direct Ownership Interest Dec 1, 2007 99%
Operational/Managerial Control Dec 1, 2007
Jessica Morgan Individual Corporate DirectorBoard Member/Director Jan 1, 2021

Owners & managing parties with NPI records 1

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

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 190

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

View all 190

NPI Registry JSON

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

{
    "created_epoch": "1665100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665100800000",
    "number": "1942925326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1517",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978010410",
            "telephone_number": "877-708-1119",
            "fax_number": "541-278-8349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "531 SE CLAY ST",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973382865",
            "telephone_number": "971-612-6100",
            "fax_number": "971-612-6101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAXIS HEALTH, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-07",
        "last_updated": "2022-10-07",
        "certification_date": "2022-10-05",
        "status": "A",
        "authorized_official_last_name": "REAGAN",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "541-966-6136"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dallas Family Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dallas, OR

Sources for this page

Verify at the official NPI Registry.