NPIMap

Organization Active NPI

Providence Health & Services - Oregon

Doing business as Providence Medical Group South

  • Clinic/Center
  • Phoenix, OR
National Provider Identifier
1992882500
Registry record updated Nov 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PROVIDENCE HEALTH & SERVICES - OREGON
Doing business as
Providence Medical Group South
Practice address
205 N Phoenix Rd
Suite a
Phoenix, OR 97535-9104
Phone
(541) 732-5760
Fax
(541) 732-3406
NPI assigned
Nov 1, 2006
Last updated
Nov 19, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HEALTH & SERVICES - OREGONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 19, 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
Asst Secretary for Enrollment
Phone
(425) 525-5392

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

205 N Phoenix Rd
Suite a
Phoenix, OR 97535-9104

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494

Other identifiers 2

IdentifierTypeStateIssuer
278307MedicaidOR
CG6801OtherORRAIL ROAD MEDIARE

Other names 1

  • PROVIDENCE MEDICAL GROUP SOUTH Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040310000315 OR Part B Supplier - Clinic/Group Practice 5294623245 Receives reassigned benefits from 200 practitioners
25 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Central Point, OR; Medford, OR; Grants Pass, OR; Eagle Point, OR

Other NPIs on the same Medicare enrollment 25

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

View all 25

National Provider Directory

National Provider Directory
Part of
Providence Health Service-

Locations

524 Manzanita St
Central Point, OR 97502
Phone (541) 200-2900

1619 NW Hawthorne Ave
Ste 206
Grants Pass, OR 97526
Phone (541) 479-5324

1691 NW Hawthorne Ave Ste 201
Grants Pass Cardiology
Grants Pass, OR 97526
Phone (541) 732-7850

675 N 5th St
Jacksonville, OR 97530
Phone (432) 638-5747

1610 E McAndrews Rd
Bldg M
Medford, OR 97504
Phone (541) 772-9449

1698 E McAndrews Rd
Ste 1160
Medford, OR 97504
Phone (541) 732-7874

1698 E McAndrews Rd
Ste 280
Medford, OR 97504
Phone (541) 204-1699

25 Erickson Ave
Shady Cove, OR 97539
Phone (541) 816-4415

Practitioners & affiliated clinicians

Practitioners 183

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.

View all 183

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763510400000",
    "number": "1992882500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "503-215-6494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N PHOENIX RD",
            "address_2": "SUITE A",
            "city": "PHOENIX",
            "state": "OR",
            "postal_code": "975359104",
            "telephone_number": "541-732-5760",
            "fax_number": "541-732-3406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "enumeration_date": "2006-11-01",
        "last_updated": "2025-11-19",
        "certification_date": "2025-11-19",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASST SECRETARY FOR ENROLLMENT",
        "authorized_official_telephone_number": "425-525-5392",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "278307",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDIARE",
            "identifier": "CG6801",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE MEDICAL GROUP SOUTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.