Peacehealth

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

140711 Issued in OR

Legal business name

PEACEHEALTH

Doing business as

Peace Harbor Medical Center

Practice address

380 9TH St
Florence, OR 97439-9470

Phone

(541) 997-7134

Fax

(541) 902-7533

NPI assigned

Nov 9, 2006

Last updated

Apr 8, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Richard L Yecny

Title

Ceo

Phone

(541) 902-6540

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Peace Harbor Medical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in OR, CA, NV, CO, NM, PA, UT, TN, OH, TX, VA, GA, NC, IA, MT15 enrollments

Enrollment records 15

Other NPIs with the same Medicare PAC ID 2

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

• Peacehealth

  dba Peace Harbor Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Florence, OR
  • NPI 1356459606

  4587573001

  Same PAC ID
• Peacehealth

  dba Peace Harbor Medical Center

  • Critical Access Hospital
  • Florence, OR
  • NPI 1578552402

  4587573001

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

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

• Peacehealth

  dba Peace Harbor Medical Center

  • Critical Access Hospital
  • Florence, OR
  • NPI 1578552402

  O20031215000598

  Same enrollment

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Peacehealth

  dba PeaceHealth Home Health of Whatcom County

  • Home Health Agency
  • Bellingham, WA
  • NPI 1710639901

  Member Of

  NPD member

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Regency Florence LLC

  • Skilled Nursing Facility
  • Florence, OR
  • NPI 1841238425

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Practitioners 204

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.

• Stephen Samuel Kerner, D.O.

  • Family Medicine Physician
  • Florence, OR
  • NPI 1073690434
  Medicare reassignment Care Compare group NPD
• Mohamad A Sabbah, M.D

  • Internal Medicine Physician
  • Florence, OR
  • NPI 1144551128
  Medicare reassignment Care Compare group NPD
• Nora Brigitta Kirschner, MD

  • Internal Medicine Physician
  • Yakima, WA
  • NPI 1174577597

  OR

  Medicare reassignment Care Compare group NPD
• Joan C Tash, CRNA

  • Certified Registered Nurse Anesthetist
  • Wichita, KS
  • NPI 1982853412

  OR

  Medicare reassignment Care Compare group NPD
• Erin Reid Wray, MD

  • Internal Medicine Physician
  • Owensboro, KY
  • NPI 1881857357

  OR

  Medicare reassignment Care Compare group NPD
• Dustin Jay Degman, CRNA

  • Certified Registered Nurse Anesthetist
  • Asheville, NC
  • NPI 1982617015

  OR

  Medicare reassignment Care Compare group
• Ossama Al Masalmeh, M.D.

  • Hospitalist Physician
  • Springfield, OR
  • NPI 1851654776
  Medicare reassignment NPD
• Samir Bir Ale, MD

  • Family Medicine Physician
  • Coos Bay, OR
  • NPI 1447538533
  Medicare reassignment NPD
• Brad Anderson, M.D.

  • Emergency Medicine Physician
  • Eugene, OR
  • NPI 1295757516
  Medicare reassignment NPD
• Keith Douglas Balderston, MD

  • Maternal & Fetal Medicine Physician
  • Springfield, OR
  • NPI 1871525337
  Medicare reassignment NPD
• Raj B. Baman, D.O.

  • Emergency Medicine Physician
  • Lincoln City, OR
  • NPI 1326085937
  Medicare reassignment NPD
• David Keith Barton, PA-C

  • Physician Assistant
  • Florence, OR
  • NPI 1487137782
  Medicare reassignment NPD

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365379200000",
    "number": "1982774378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24410",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974020451",
            "telephone_number": "541-902-6140",
            "fax_number": "541-902-7533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 9TH ST",
            "city": "FLORENCE",
            "state": "OR",
            "postal_code": "974399470",
            "telephone_number": "541-997-7134",
            "fax_number": "541-902-7533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACEHEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2013-04-08",
        "status": "A",
        "authorized_official_last_name": "YECNY",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-902-6540"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "OR",
            "license": "140711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "055322",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peace Harbor Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Deborah Lynn Pasternak, LMT
• Peacehealth (Peace Harbor Hospice)
• Peacehealth (Peace Harbor Home Health)
• Peacehealth (Peace Harbor Medical Center)
• Peacehealth (Peace Harbor Medical Center)
• Paul E. Pearson, M.D.
• Cameron Peddycord
• Jacqueline Marie Pendergrass, LPN
• Colleen Marie Pennington, CST/CSFA
• Lillian Petersen, CDL, LD

• Multi-Specialty Clinic/Center in Florence, OR
• Providers in Florence, OR by specialty
• Multi-Specialty Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.