PROVIDENCE HEALTH & SERVICES - OREGON
NPI 1063705887
Clinic/Center - Multi-Specialty in Medford, OR
NPI Status: Active since May 26, 2011
Contact Information
920 ROYAL AVE
MEDFORD, OR
ZIP 97504
Phone: (541) 732-8400
Fax: (541) 732-8401
- Organization
- Clinic/Center
- Multi-Specialty
- CLIA Number: 38D2109826
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 03-01-2026
About PROVIDENCE HEALTH & SERVICES - OREGON
This page provides the complete NPI Profile along with additional information for Providence Health & Services - Oregon, a provider established in Medford, Oregon operating as a Clinic/center, focusing in multi-specialty . The healthcare provider is registered in the NPI registry with number 1063705887 assigned on May 2011. The practitioner's primary taxonomy code is 261QM1300X. The provider is registered as an organization and their NPI record was last updated May 2025. The provider's
- NPI
- 1063705887
- Provider Legal Name
- PROVIDENCE HEALTH & SERVICES - OREGON
- Other Organization Name
- Other Name Type
- (6)
- Entity Type
- Organization
- Location Address
- 920 ROYAL AVE MEDFORD, OR 97504
- Location Phone
- (541) 732-8400
- Location Fax
- (541) 732-8401
- Mailing Address
- PO BOX 3158 PORTLAND, OR 97208
- Mailing Phone
- (503) 215-6494
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 05-26-2011
- Last Update Date
- 05-12-2025
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Multi-Specialty
- Taxonomy Code
- 261QM1300X
- Type
- Ambulatory Health Care Facilities
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 38D2109826
- Facility Type
- Physician Office
- Certificate Effective Date
- March 02, 2024
- Certificate Expiration Date
- March 01, 2026
- Laboratory Director
- GRANT JOLLIFFE FNP
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Providence Health & Services - Oregon to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 0 | 6 | 3 | 7 | 0 | 5 | 8 | 8 | 7 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 0 | 12 | 3 | 14 | 0 | 10 | 8 | 16 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 0 + 1 + 2 + 3 + 1 + 4 + 0 + 1 + 0 + 8 + 1 + 6 + 24 = 53 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 60 - 53 = 7 | 7 | ||||||||
The NPI number 1063705887 is valid because the calculated check digit 7 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 9 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1275821746 | OREGON EAR NOSE AND THROAT SURGERY Organization | Clinic/Center (Ambulatory Surgical) | 920 ROYAL AVE MEDFORD, OR 97504 (541) 779-7331 |
| 1114927753 | MICHAEL STEVEN NARUS DO Individual | Psychiatry & Neurology (Neurology with Special Qualifications in Child Neurology) | 920 ROYAL AVE MEDFORD, OR 97504 (541) 732-8400 |
| 1881006997 | ERIN MARIE DITTMER NP Individual | Nurse Practitioner (Adult Health) | 920 ROYAL AVE MEDFORD, OR 97504 (541) 732-8400 |
| 1639279243 | DONALD M OLSON M.D. Individual | Psychiatry & Neurology (Neurology with Special Qualifications in Child Neurology) | 920 ROYAL AVE MEDFORD, OR 97504 (541) 732-8400 |
| 1720424591 | MINJI KIM M.D. Individual | Psychiatry & Neurology (Neurology) | 920 ROYAL AVE MEDFORD, OR 97504 (541) 732-8400 |
| 1689955536 | PAWANI SACHAR M.D. Individual | Psychiatry & Neurology (Neurology) | 920 ROYAL AVE MEDFORD, OR 97504 (541) 732-8400 |
| 1396771358 | ROBERT ARTHUR EGAN MD Individual | Psychiatry & Neurology (Neurology) | 920 ROYAL AVE MEDFORD, OR 97504 (541) 732-8400 |
| 1356977144 | MARIA ELENA RIVERA FNP Individual | Nurse Practitioner | 920 ROYAL AVE MEDFORD, OR 97504 (541) 732-8300 |
| 1770583338 | WALTER GINO CARLINI MD Individual | Psychiatry & Neurology (Neurology) | 920 ROYAL AVE MEDFORD, OR 97504 (541) 732-8400 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1063705887, enumerated in the NPI registry as an "organization" on May 26, 2011
The provider is located at 920 Royal Ave Medford, Or 97504 and the phone number is (541) 732-8400
This medical organization specializes in Clinic/Center with taxonomy code 261QM1300X with a focus in Multi-Specialty
The provider's CLIA number is 38D2109826 for a "physician office" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria..
This NPI record was last updated on May 26, 2011. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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