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1890 Waite St Suite 1 North Bend OR 97459-1229 | |
| (541) 756-6232 | |
| (541) 756-6234 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1890 Waite St, North Bend, Oregon |
| Authorized Official Name and Position | Andrea Trenner (EXECUTIVE DIRECTOR/CEO) |
| Authorized Official Contact | 5417566232 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1890 Waite St Suite 1 North Bend OR 97459-1229 Ph: (541) 756-6232 | 1890 Waite St Suite 1 North Bend OR 97459-1229 Ph: (541) 756-6232 |
| NPI Number | 1619915113 |
|---|---|
| Provider Enumeration Date | 06/04/2006 |
| Last Update Date | 06/30/2017 |
| Medicare PECOS PAC ID | 5698740355 |
|---|---|
| Medicare Enrollment ID | O20040827000153 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619915113 | NPI | - | NPPES |
| 227623 | Medicaid | OR | |
| 213342 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Catherine A Gruchacz |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1205832490 PECOS PAC ID: 4880584713 Enrollment ID: I20040316000939 |
| Provider Name | Robert W Gerber |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518941350 PECOS PAC ID: 1759356413 Enrollment ID: I20040908000593 |
| Provider Name | Harold Durel Kirby |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487785697 PECOS PAC ID: 7810957511 Enrollment ID: I20041018000262 |
| Provider Name | Mark A Pasternak |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1760552483 PECOS PAC ID: 4688723471 Enrollment ID: I20090527000622 |
| Provider Name | Bhargavbhai K Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134382328 PECOS PAC ID: 3173792025 Enrollment ID: I20110809000847 |
| Provider Name | Lorraine H Davies |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1588827547 PECOS PAC ID: 8325273436 Enrollment ID: I20131027000005 |
| Provider Name | Rebecca M Rice |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104124445 PECOS PAC ID: 6204019854 Enrollment ID: I20150416000883 |
| Provider Name | Martin R Roco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255683140 PECOS PAC ID: 8123254596 Enrollment ID: I20150608003084 |
| Provider Name | Shu-wen Cheng |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043719990 PECOS PAC ID: 4284996810 Enrollment ID: I20180320001397 |
| Provider Name | Catherine M O'brien |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1871830125 PECOS PAC ID: 7113148438 Enrollment ID: I20190102001794 |
| Provider Name | Toyin A Akanni |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689141236 PECOS PAC ID: 2365789732 Enrollment ID: I20190123001344 |
| Provider Name | Adam N Clark |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699276287 PECOS PAC ID: 8426481839 Enrollment ID: I20191125002098 |
| Provider Name | Yvonne L Fenrich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376588111 PECOS PAC ID: 1759369465 Enrollment ID: I20191205001818 |
| Provider Name | Jacklyn S Hardin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235764143 PECOS PAC ID: 2365872454 Enrollment ID: I20200413001980 |
| Provider Name | Sarah B Campbell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023137171 PECOS PAC ID: 5890013395 Enrollment ID: I20200429001290 |
| Provider Name | Lori D Shott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083246730 PECOS PAC ID: 4082036470 Enrollment ID: I20200611001684 |
| Provider Name | Ya-chi C Chang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568002749 PECOS PAC ID: 9234559949 Enrollment ID: I20201019002890 |
| Provider Name | Brigett W Hollander |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578735270 PECOS PAC ID: 9931224912 Enrollment ID: I20201020003612 |
| Provider Name | Shelly A Prather |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124657887 PECOS PAC ID: 5092125732 Enrollment ID: I20201106002472 |
| Provider Name | Gail L Davie |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1811177793 PECOS PAC ID: 7315322567 Enrollment ID: I20220923002164 |
| Provider Name | Tyler D Cooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447928494 PECOS PAC ID: 2769858042 Enrollment ID: I20221012002252 |
| Provider Name | Kristen H Stewart |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1326759861 PECOS PAC ID: 8820469943 Enrollment ID: I20230126003122 |
| Provider Name | Kathryn S Mead |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497186530 PECOS PAC ID: 8820462104 Enrollment ID: I20230328002844 |
| Provider Name | Matthew D Laird |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619683224 PECOS PAC ID: 1658745880 Enrollment ID: I20230329002167 |
| Provider Name | Christina M Brakebill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992133607 PECOS PAC ID: 7416184536 Enrollment ID: I20230601000735 |
| Provider Name | Patrick J Dwyer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528145893 PECOS PAC ID: 3274562798 Enrollment ID: I20230724000035 |
| Provider Name | Rachael H Hilton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447966437 PECOS PAC ID: 8325404031 Enrollment ID: I20230821002325 |
| Provider Name | Kelly J Squire-hamblet |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1003249046 PECOS PAC ID: 0840653572 Enrollment ID: I20230829002549 |
| Provider Name | Emma Kinross |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1801586524 PECOS PAC ID: 7517321870 Enrollment ID: I20230919004290 |
| Provider Name | Amanda B Galer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609150325 PECOS PAC ID: 3476772500 Enrollment ID: I20231114003003 |
| Provider Name | Lance E Nelson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609012897 PECOS PAC ID: 3577826320 Enrollment ID: I20240105002877 |
| Provider Name | Meggan H Mclarrin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679939524 PECOS PAC ID: 7012368236 Enrollment ID: I20240111002702 |
| Provider Name | Charles E Majuri |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063632446 PECOS PAC ID: 9830540095 Enrollment ID: I20240111004046 |
| Provider Name | Chelsea L Lemmer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902260524 PECOS PAC ID: 9234581018 Enrollment ID: I20240117002102 |
| Provider Name | Karen B Sheelar |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467979609 PECOS PAC ID: 6800239328 Enrollment ID: I20240212001635 |
| Provider Name | Donna J Brint |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750644845 PECOS PAC ID: 1951747971 Enrollment ID: I20240313001837 |
| Provider Name | Ariahna C Hays |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306321765 PECOS PAC ID: 8022450758 Enrollment ID: I20240528001383 |
| Provider Name | Daniel B Knight |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932173127 PECOS PAC ID: 8820026396 Enrollment ID: I20240729001991 |
| Provider Name | Cheryl A Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174182141 PECOS PAC ID: 0244396232 Enrollment ID: I20240904004637 |
| Provider Name | Jennifer M Palmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649602301 PECOS PAC ID: 3870728090 Enrollment ID: I20240912002808 |
| Provider Name | Kimberly A Talley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376277665 PECOS PAC ID: 8921474206 Enrollment ID: I20241009003566 |
| Provider Name | Stormy M Iverson |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1356177000 PECOS PAC ID: 3072049337 Enrollment ID: I20241210001606 |
Waterfall Clinic, Incorporated Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1890 Waite St Ste 1, North Bend, OR 97459 Phone: 541-756-6232 | |
Waterfall Clinic, Incorporated Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 93670 Viking Ln, North Bend, OR 97459 Phone: 541-756-6232 Fax: 541-756-6234 | |
Inland Point Senior Estates Jv Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2265 Inland Drive, North Bend, OR 97459 Phone: 541-756-9740 Fax: 541-756-9739 |