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2589 Nw Edenbower Blvd Roseburg OR 97471-6220 | |
| (541) 672-8533 | |
| (855) 670-1791 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2589 Nw Edenbower Blvd, Roseburg, Oregon |
| Authorized Official Name and Position | Sharon A Stanphill (CHIEF HEALTH OFFICER) |
| Authorized Official Contact | 5416728533 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2371 Ne Stephens St Ste 200 Roseburg OR 97470-1399 Ph: (541) 672-8533 | 2589 Nw Edenbower Blvd Roseburg OR 97471-6220 Ph: (541) 672-8533 |
| NPI Number | 1063502714 |
|---|---|
| Provider Enumeration Date | 10/13/2006 |
| Last Update Date | 11/19/2021 |
| Medicare PECOS PAC ID | 8921099474 |
|---|---|
| Medicare Enrollment ID | O20071218000285 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063502714 | NPI | - | NPPES |
| 500745176 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Kevin Michael Mcdonnell |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1578548533 PECOS PAC ID: 1052309101 Enrollment ID: I20040505001457 |
| Provider Name | James Turner |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1790760064 PECOS PAC ID: 9931159886 Enrollment ID: I20050420000438 |
| Provider Name | Delphia Clarke |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1255316873 PECOS PAC ID: 0749180644 Enrollment ID: I20050420000467 |
| Provider Name | Kimberly A Cotton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194757385 PECOS PAC ID: 5193768588 Enrollment ID: I20050607000381 |
| Provider Name | Patricia Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265507362 PECOS PAC ID: 9436181591 Enrollment ID: I20050909000195 |
| Provider Name | Benjamin Strong |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1205811569 PECOS PAC ID: 8426048232 Enrollment ID: I20051004000655 |
| Provider Name | Susan Pinero |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1164437026 PECOS PAC ID: 0042239428 Enrollment ID: I20051115000498 |
| Provider Name | Cristina Cavazos |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1992922082 PECOS PAC ID: 2769577576 Enrollment ID: I20080723000232 |
| Provider Name | Perry P Kaneriya |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1316925928 PECOS PAC ID: 1153359054 Enrollment ID: I20090914000227 |
| Provider Name | William F Briggs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932392859 PECOS PAC ID: 0941394548 Enrollment ID: I20100830000982 |
| Provider Name | David M Moon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1548213812 PECOS PAC ID: 2769476555 Enrollment ID: I20130715000777 |
| Provider Name | Karen S Caldemeyer |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1679511356 PECOS PAC ID: 9931003506 Enrollment ID: I20130726000311 |
| Provider Name | John Gambino |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1093773533 PECOS PAC ID: 2062484314 Enrollment ID: I20130912000327 |
| Provider Name | John Derek Lewis |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1396916656 PECOS PAC ID: 1052589199 Enrollment ID: I20131019000173 |
| Provider Name | Gregory Kenyherz |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1417953795 PECOS PAC ID: 1759462625 Enrollment ID: I20131108001494 |
| Provider Name | Taro Aikawa |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1144265455 PECOS PAC ID: 5395700108 Enrollment ID: I20131230001614 |
| Provider Name | Hugh R Henderson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437226008 PECOS PAC ID: 7517141104 Enrollment ID: I20140607000094 |
| Provider Name | Odiri Akushe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023496726 PECOS PAC ID: 3072524685 Enrollment ID: I20150805009082 |
| Provider Name | Adam Hecht |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1619957834 PECOS PAC ID: 4587695085 Enrollment ID: I20160825001755 |
| Provider Name | Scott Kerns |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1336137165 PECOS PAC ID: 9931145331 Enrollment ID: I20161004002112 |
| Provider Name | Cynthia Tortorelli |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326001835 PECOS PAC ID: 4688664667 Enrollment ID: I20170331000755 |
| Provider Name | Julie Shaffrey |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1639154982 PECOS PAC ID: 1850327370 Enrollment ID: I20170407001732 |
| Provider Name | Archana Siddalingappa |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1154632859 PECOS PAC ID: 9537473939 Enrollment ID: I20170815001354 |
| Provider Name | Lauren M Haddock |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1386127298 PECOS PAC ID: 5496009060 Enrollment ID: I20181117000114 |
| Provider Name | Duane Charles Wilson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1780664664 PECOS PAC ID: 0345137907 Enrollment ID: I20190318000838 |
| Provider Name | Micah D Tovey |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1053543967 PECOS PAC ID: 8022270362 Enrollment ID: I20190514002397 |
| Provider Name | James Manwill |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1952371940 PECOS PAC ID: 6507968377 Enrollment ID: I20200930000497 |
| Provider Name | Marwah Helmy |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1841276730 PECOS PAC ID: 0446302079 Enrollment ID: I20201021000605 |
| Provider Name | John Vantassel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1063443638 PECOS PAC ID: 4183633225 Enrollment ID: I20201021001155 |
| Provider Name | Andrew M Delgado |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518368331 PECOS PAC ID: 8729306337 Enrollment ID: I20201111002089 |
| Provider Name | Ansley Hill |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1407390206 PECOS PAC ID: 8224312921 Enrollment ID: I20201208002098 |
| Provider Name | Robert Walker |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1568626794 PECOS PAC ID: 5092873299 Enrollment ID: I20210415001619 |
| Provider Name | Alix Hopp |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1154770774 PECOS PAC ID: 8729356829 Enrollment ID: I20211230000469 |
| Provider Name | Paulette A Kirby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033189790 PECOS PAC ID: 2567447097 Enrollment ID: I20220103000474 |
| Provider Name | Arlene Spertus |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275690182 PECOS PAC ID: 3971674227 Enrollment ID: I20220221002044 |
| Provider Name | Dawn Rae Bankson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912238080 PECOS PAC ID: 0941331151 Enrollment ID: I20220523001204 |
| Provider Name | Michelle Phelps |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790243988 PECOS PAC ID: 0648604546 Enrollment ID: I20230728002163 |
| Provider Name | Benjamin Edward Jeppe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598702367 PECOS PAC ID: 9234227240 Enrollment ID: I20231215001784 |
| Provider Name | Lori M. Hillard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760957880 PECOS PAC ID: 7214373307 Enrollment ID: I20240312000759 |
| Provider Name | Elizabeth Claire Grubb |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1366079766 PECOS PAC ID: 3577905629 Enrollment ID: I20240521004031 |
| Provider Name | Kimberlly Joy Stevens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851828511 PECOS PAC ID: 0042587024 Enrollment ID: I20240528003328 |
| Provider Name | Peyton Michael Rondeau |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1710711452 PECOS PAC ID: 1759822513 Enrollment ID: I20240919002524 |
| Provider Name | Kimberly Brent |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649897281 PECOS PAC ID: 3072044031 Enrollment ID: I20241001002093 |
| Provider Name | Jennifer Schenk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912659418 PECOS PAC ID: 6103203369 Enrollment ID: I20241008000392 |
| Provider Name | Vanessa Copeland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548761000 PECOS PAC ID: 2466716188 Enrollment ID: I20241123000433 |
A.k. Gombart M.d.p.c Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 532 W Umpqua St, Roseburg, OR 97470 Phone: 541-673-0133 | |
Roseburg Clinic Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2750 W Harvard Ave, Roseburg, OR 97471 Phone: 541-673-8988 Fax: 541-672-8103 | |
Douglas Medical Clinic Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1813 W Harvard Ave, Suite 201, Roseburg, OR 97470 Phone: 541-440-6390 Fax: 541-440-6392 | |
Laurence M Sharp Do Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1813 W Harvard Ave, Suite 426, Roseburg, OR 97471 Phone: 541-459-1611 Fax: 541-459-5741 | |
Gordon F. Rose, Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 544 W Umpqua St Ste 104, Roseburg, OR 97470 Phone: 541-673-3334 Fax: 541-673-0814 |