NPIMap

Organization Active NPI

Mosaic Medical

  • Federally Qualified Health Center (FQHC)
  • Redmond, OR
National Provider Identifier
1992354567
Registry record updated Sep 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MOSAIC MEDICAL
Practice address
1250 SW Veterans Way Ste 120
Redmond, OR 97756-2588
Phone
(541) 408-9486
Fax
(541) 647-2793
NPI assigned
Sep 6, 2019
Organization subpart
Yes
Parent organization
MOSAIC MEDICALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 6, 2019

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

Authorized official

Name
Bobbi Jolyne Surplus
Title
Revenue Cycle Manager
Phone
(541) 408-9486

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1250 SW Veterans Way Ste 120
Redmond, OR 97756-2588

Mailing address

600 SW Columbia St Ste 6210
Bend, OR 97702-1099
Phone (541) 408-9486

National Provider Directory

National Provider Directory
Tax ID family
Mosaic Medical28 organizations share this tax ID, including this one
Part of
Mosaic Medical

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1567728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567728000000",
    "number": "1992354567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 SW COLUMBIA ST STE 6210",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021099",
            "telephone_number": "541-408-9486",
            "fax_number": "541-647-2793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 SW VETERANS WAY STE 120",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977562588",
            "telephone_number": "541-408-9486",
            "fax_number": "541-647-2793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSAIC MEDICAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOSAIC MEDICAL",
        "enumeration_date": "2019-09-06",
        "last_updated": "2019-09-06",
        "status": "A",
        "authorized_official_last_name": "SURPLUS",
        "authorized_official_first_name": "BOBBI",
        "authorized_official_middle_name": "JOLYNE",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "541-408-9486"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redmond, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.