Grande Ronde Hospital Inc.
Organization Active NPI Obstetrics & Gynecology Physician · La Grande, OR
NPI 1972545895 · NPPES record last updated Nov 8, 2007
Key facts
- NPI
- 1972545895
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 394792 (OR)
- Legal business name
- GRANDE RONDE HOSPITAL INC.
- Practice address
- 610 Sunset Dr
La Grande, OR 97850-1248 - Phone
- (541) 963-2216
- Fax
- (541) 962-1042
- NPI assigned
- Jun 12, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. James Mattes
- Title
- President
- Phone
- (541) 963-1469
Owners & managing parties with NPI records 3
-
Blake Gornowicz, MD
-
Stephen McLean, DMD
Other NPIs on the same Medicare enrollment 4
Related certifications (CCN) 7
Practitioners 3
-
Milo Lavon Hibbert, M.D.
-
Jill Malynn Parsons, RN, WHCNP
-
Brook Allen Thomson, M.D.
Affiliated clinicians 219
-
Jacquelyn Denise Adams, DNP, FNP
-
Fadi Husayn Akoum, M.D.
-
Monte W. Anderson, PA-C
-
Kylie Andrews, PA
-
Weston Baker, MD
-
Maricela Elena Bandel-Ramirez, AGACNP
-
Tempie Bartell, FNP-C
-
Andrew Dale Baum, DPM
-
Raffaella Sappe Betza, M.D.
-
Manmohan S Biring, M.D.
-
Heather R Brock, ARNP
-
Marcus Paul Carr, M.D.
-
Neil J Carroll, MD
-
Bradley Robert Close, CRNA
-
Bryan Richard Conklin, MD PC
-
Kerma Luann Cook, ANP
-
Aaron Randy Cooper, PA-C
-
Brooke Davis, DO
Medicare Care Compare: Hospital
- Listed as
- Grande Ronde Hospital
- Overall star rating
- ★★★★★ 5 of 5
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OR
Hospital certification: CCN 381321
- Legal name
- GRANDE RONDE HOSPITAL INC
- Doing business as
- GRANDE RONDE HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Aug 1, 2004
- Last certification
- Apr 5, 2013
- Beds
- 49 (25 certified)
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 1, 1986 in OR
- Enrollment address
- 900 Sunset Dr
La Grande, OR 97850-1387
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Stephen M McLean |
Corporate Director | Jan 1, 2016 | |
| Samuel H Kimball |
Corporate Director | Feb 22, 2017 | |
| Michael a Hetrick |
Corporate Director | Jan 1, 2016 | |
| Suzanne D Hopper |
Corporate Director | Jan 1, 2015 | |
| Blake a Gornowicz |
Corporate Director | Jan 1, 2022 | |
| Robert P Seymour |
W-2 Managing Employee | Jan 1, 2017 | |
| Lara Kay Moore |
Corporate Director | Nov 16, 2016 | |
| John Garlitz |
Corporate Director | Jan 1, 2016 | |
| Nicholas Alvin Huelter |
Corporate Director | Jan 1, 2021 | |
| Jeremy P Davis |
Corporate Officer |
Nov 26, 2018 | |
| Teri S Champlin |
Corporate Director | Jan 1, 2014 | |
| Jared Cole Rogers |
Corporate Director | Dec 24, 2019 | |
| Robert Coulter |
Corporate Director | Jan 1, 2021 | |
| Michael E Billman |
Corporate Director | Jan 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031124000758 | OR | Part B Supplier - Clinic/Group Practice | 0547170789 |
Receives reassigned benefits from 163 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: La Grande, OR |
| O20061104000155 | OR | Part a Provider - Critical Access Hospital | 0547170789 |
Receives reassigned benefits from 154 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: La Grande, OR |
National Provider Directory
Locations
610 Sunset Dr
La Grande, OR 97850
Phone (541) 663-3175
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician |
207V00000X | 394792 | OR | Yes |
Addresses
Primary practice location
610 Sunset Dr
La Grande, OR 97850-1248
Mailing address
610 Sunset Dr
La Grande, OR 97850-1248
Phone (541) 963-2216
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 067801 | Medicaid | OR |
Other names
- Grande Ronde Hospital Womens Clinic
Other providers in La Grande, OR
- Stanley Keith Graham
- Grande Ronde Child Center, Inc.
- Grande Ronde Chiropractic Clinic, LLC
- Grande Ronde Hospital
- Grande Ronde Hospital Home Oxygen
- Grande Ronde Hospital, Inc
- Grande Ronde Hospital, Inc
- Grande Ronde Hospital, Inc
- Grande Ronde Hospital, Inc
- Grande Ronde Hospital, Inc.
All providers in La Grande, OR · Obstetrics & Gynecology Physician in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 8, 2007. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.