Providence Health & Services Oregon
Organization Active NPI Rural Health Clinic/Center · Warrenton, OR
NPI 1972039170 · NPPES record last updated May 21, 2025
Key facts
- NPI
- 1972039170
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- PROVIDENCE HEALTH & SERVICES OREGON
- Practice address
- 113 S Highway 101
Warrenton, OR 97146-9314 - Phone
- (503) 861-6500
- NPI assigned
- May 8, 2017
- Organization subpart
- No
Authorized official
- Name
- Donald W Anderson Jr.
- Title
- Assistant Secretary Enrollments
- Phone
- (425) 358-9786
Owners & managing parties with NPI records 1
Other NPIs on the same Medicare enrollment 5
Other NPIs with the same Medicare PAC ID 4
Related certifications (CCN) 1
Facilities with the same owner 139
Practitioners 311
-
Jason Shawn Bensch, M.D.
-
Steven James Blackthorne, M.D.
-
Anna Marie Bovee, FNP
-
Xiaohong Cai, MD
-
Todd A Caulfield, MD
-
Zachary Caverley, PA
-
Christopher Lewis Craft, FNP-BC
-
Steven Kyle Dailey, M.D.
-
Daniel Luke Dowling, PSY.D.
-
James B Durham, MD
-
Casseopia Fisher, AGACNP
-
Michael J Forrest, P.A.
-
Theodore Allen Foster III, D.O., M.P.H
-
Eric Ian Friedman, M.D.
-
Dominique Greco, MD
-
Candace Lynn Gregory, DPM
-
Jennifer Shannon Haag, AGPCNP
-
Donna Lee Hammar, FNP
-
Jayson B Hieter, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OR
Rural health clinic certification: CCN 388530
- Legal name
- PROVIDENCE HEALTH & SERVICES OREGON
- Doing business as
- PROVIDENCE SEASIDE HOSPITAL - PROVIDENCE WARRENTON CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Feb 28, 2018
- Last certification
- Mar 1, 2024
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Feb 20, 1934 in OR
- Enrollment address
- 113 S Highway 101
Warrenton, OR 97146-9314 - Related CCNs
- 381303
All disclosed owners & managing parties 26
| Name | Role | Since | Share |
|---|---|---|---|
| Diane L Hejna |
Corporate Director |
Jul 1, 2016 | |
| Richard S Blair |
Corporate Director |
Jul 1, 2016 | |
| Providence Health & Services-Oregon |
5% Or Greater Direct Ownership Interest | May 14, 2010 | 100% |
| Marvin O'Quinn |
Corporate Director |
Jan 1, 2024 | |
| Linda Buck |
Corporate Director |
Jan 1, 2025 | |
| Providence Health & Services - Washington |
Operational/Managerial Control | May 14, 2010 | |
| Mary E Lyons |
Corporate Director |
Jul 1, 2016 | |
| Phyllis M Hughes |
Corporate Director |
Jan 1, 2014 | |
| Rogelio Riojas |
Corporate Director |
Jan 1, 2025 | |
| James Martin |
Corporate Officer | Jan 13, 2023 | |
| Charles Wallace Sorenson |
Corporate Director |
Jan 1, 2019 | |
| Pamela J Cooper |
W-2 Managing Employee |
Oct 1, 2000 | |
| Donald Wayne Anderson |
Corporate Officer |
Jan 1, 2017 | |
| Gregory David Hoffman |
Corporate Officer |
Oct 1, 2020 | |
| Isiaah D Crawford |
Corporate Director |
Jan 1, 2012 | |
| Melissa Ann Damm |
W-2 Managing Employee |
Jul 20, 2016 | |
| Rebecca F Coplin |
W-2 Managing Employee |
Jan 1, 2025 | |
| Donna Markham |
Corporate Director |
Jan 1, 2024 | |
| Michael W Murphy |
Corporate Director |
Jan 1, 2020 | |
| Providence Health & Services |
Other | Jul 1, 2016 | |
| Mary Beth Kingston |
Corporate Director |
Sep 1, 2022 | |
| Eric D Sprunk |
Corporate Director | Jan 1, 2022 | |
| Anna R Newsom |
Corporate Officer | May 13, 2022 | |
| Darryl Elmouchi |
Corporate Officer |
Apr 1, 2025 | |
| Karin Dufault |
Corporate Director |
Jan 1, 2025 | |
| Providence St. Joseph Health |
Other | Jul 1, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040102000768 | OR | Part B Supplier - Clinic/Group Practice | 1557260106 |
Receives reassigned benefits from 319 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cannon Beach, OR; Seaside, OR; Warrenton, OR |
| O20170706001783 | OR | Part a Provider - Rural Health Clinic | 1557260106 | Practice locations: Warrenton, OR |
National Provider Directory
Locations
3621 Highway 101 N
Gearhart, OR 97138
Phone (503) 717-7788
727 S Wahanna Rd
Ste 220230
Seaside, OR 97138
Phone (503) 717-7000
145 S Highway 101
Ste 113
Warrenton, OR 97146
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
113 S Highway 101
Warrenton, OR 97146-9314
Mailing address
PO Box 31001-4199
Pasadena, CA 91110-4199
Phone (503) 893-7120
Other practice location 1
171 S Highway 101
Warrenton, OR 97146-9314
Phone (503) 861-6500
Other names
- PROVIDENCE SEASIDE HOSPITAL - PROVIDENCE WARRENTON CLINIC
- Providence Seaside Hospital, Providence Warrenton Clinic
Other providers in Warrenton, OR
- Madeline Suzanne Pitts
- Carin Kay Pluedeman
- Anne Plum
- Justin C Powell
- Rebecca Prichard
- Radiant Care Afh 'LLC'
- Radiant Care Afh LLC
- Claire Margaret Reilly
- Susan Haynes Rhay
- Edith Riper
All providers in Warrenton, OR · Rural Health Clinic/Center in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.