NPIMap

Organization Active NPI

Providence Health & Services Oregon

Doing business as Prov Health Sys-OR Shared-Svs Div

  • Community Based Hospice Care Agency
  • Medford, OR
National Provider Identifier
1952495772
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
PROVIDENCE HEALTH & SERVICES OREGON
Doing business as
Prov Health Sys-OR Shared-Svs Div
Practice address
2033 Commerce Dr
Medford, OR 97504-9744
Phone
(541) 732-6500
NPI assigned
Oct 3, 2006
Last updated
May 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2025

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

Authorized official

Name
Donald Wayne Anderson Jr.
Title
Assistant Secretary Enrollment
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X NU Primary

Addresses

Primary practice location

2033 Commerce Dr
Medford, OR 97504-9744

Mailing address

4400 NE Halsey St
Building 1, Ste 129
Portland, OR 97213-1545
Phone (503) 215-4601

Other identifiers 5

IdentifierTypeStateIssuer
132204MedicaidOR
303804000001OtherORPHP
084013000OtherORBLUE CROSS HOSPICE PD
930386912-03OtherORODS
026699000OtherORBLUE CROSS FFS

Other names 1

  • Prov Health Sys-OR Shared-Svs Div Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141212000693 OR Part A Provider - Hospice 6305755000 Practice locations: Medford, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952495772. Details of each certification follow.

Hospice certification: CCN 381506

Legal name
PROVIDENCE HEALTH & SERVICES OREGON
Doing business as
PROVIDENCE MEDFORD HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 27, 1988
Last certification
Apr 4, 2019
Ownership / control type
Non-Profit - Church
Organization structure
CorporationNon-profit
Incorporated
Feb 20, 1934 in OR
Enrollment address
2033 Commerce Dr
Medford, OR 97504-9744

Other NPIs with the same Medicare PAC ID 8

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Providence Medford HospiceCCN 381506 · All quality measures
Ownership
Non-Profit
Certified
Jun 27, 1988
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Sisters of Providence H18 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

Locations

4400 NE Halsey St
Ste 129
Portland, OR 97213

Ownership & related parties

All disclosed owners & managing parties 27

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

NameRoleSinceShare
Diane L Hejna Individual Corporate DirectorBoard Member Jul 1, 2016
Richard S Blair Individual Corporate DirectorBoard Member Jul 1, 2016
Providence Health & Services-Oregon Organization, Renton, WA Non-profit 5% Or Greater Direct Ownership Interest Sep 6, 2012 100%
Marvin O'Quinn Individual Corporate DirectorBoard Member Jan 1, 2024
Juan Carlos Iregui Individual W-2 Managing EmployeeMD; Feb 10, 2026
Linda Buck Individual Corporate DirectorBoard Member Jan 1, 2025
Terri P Warren Individual W-2 Managing EmployeeVP/Chief Community Services Nov 1, 2022
Providence Health & Services - Washington Organization, Renton, WA Corporation, Non-profit Operational/Managerial Control Jan 10, 2011 100%
Mary E Lyons Individual Corporate DirectorBoard Member Jul 1, 2016
Nicole Sikes Individual W-2 Managing EmployeeDirector Aug 22, 2022
Phyllis M Hughes Individual Corporate DirectorBoard Member Jan 1, 2014
Rogelio Riojas Individual Corporate DirectorBoard Member Jan 1, 2025
James Martin Individual Corporate OfficerAsst Treasurer Jan 13, 2023
Charles Wallace Sorenson Individual Corporate DirectorBoard Member Jan 1, 2019
Donald Wayne Anderson Individual Corporate OfficerAsst Sec of Enrollment/Dir Reimb Ad Jan 1, 2017
Gregory David Hoffman Individual Corporate OfficerEvp/Cfe Oct 1, 2020
Isiaah D Crawford Individual Corporate DirectorBoard Member Feb 1, 2012
Donna Markham Individual Corporate DirectorBoard Member Jan 1, 2024
Michael W Murphy Individual Corporate DirectorBoard Member Jan 1, 2020
Providence Health & Services Organization, Renton, WA Corporation, Non-profit Other Jul 1, 2016
Mary Beth Kingston Individual Corporate DirectorBoard Member Sep 1, 2022
Lorraine Boone Individual W-2 Managing EmployeeAd; Sep 1, 1998
Eric D Sprunk Individual Corporate DirectorBoard Member Jan 1, 2022
Anna R Newsom Individual Corporate OfficerCorporate Secretary May 13, 2022
Darryl Elmouchi Individual Corporate OfficerPresident Apr 1, 2025
Karin Dufault Individual Corporate DirectorBoard Member Jan 1, 2025
Providence St. Joseph Health Organization, Renton, WA Corporation, Non-profit Other Jul 1, 2016

Owners & managing parties with NPI records 2

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

Facilities with the same owner 139

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

View all 139

Practitioners & affiliated clinicians

Affiliated clinicians 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1952495772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 NE HALSEY ST",
            "address_2": "BUILDING 1, STE 129",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972131545",
            "telephone_number": "503-215-4601",
            "fax_number": "503-215-4624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2033 COMMERCE DR",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975049744",
            "telephone_number": "541-732-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "132204",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP",
            "identifier": "303804000001",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS HOSPICE PD",
            "identifier": "084013000",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ODS",
            "identifier": "930386912-03",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS FFS",
            "identifier": "026699000",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prov Health Sys-OR Shared-Svs Div",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Prov Health Sys-OR Shared-Svs Div",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.