| Peacehealth Medical Group Cottage Grove | |
|
98 W Oregon Ave Creswell OR 97426-9259 | |
| (541) 222-7700 | |
| Not Available |
| Full Name | Peacehealth Medical Group Cottage Grove |
|---|---|
| Speciality | Clinic/Center |
| Location | 98 W Oregon Ave, Creswell, Oregon |
| Authorized Official Name and Position | Wendy Apland (CFO) |
| Authorized Official Contact | 5416863968 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peacehealth Medical Group Cottage Grove Po Box 24410 Eugene OR 97402-0451 Ph: (360) 729-1566 | Peacehealth Medical Group Cottage Grove 98 W Oregon Ave Creswell OR 97426-9259 Ph: (541) 222-7700 |
| NPI Number | 1780631267 |
|---|---|
| Provider Enumeration Date | 05/28/2006 |
| Last Update Date | 06/04/2013 |
| Medicare PECOS PAC ID | 9436060530 |
|---|---|
| Medicare Enrollment ID | O20040616001333 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780631267 | NPI | - | NPPES |
| 130008 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Erin P Reilly |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1285602086 PECOS PAC ID: 4385639277 Enrollment ID: I20040419001598 |
| Provider Name | Nicholas L Gideonse |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639184146 PECOS PAC ID: 8123016276 Enrollment ID: I20040505001499 |
| Provider Name | Julie C Scalisi |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1396773032 PECOS PAC ID: 4486660537 Enrollment ID: I20060227000327 |
| Provider Name | Michael L Moser |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427027556 PECOS PAC ID: 3476569542 Enrollment ID: I20060227000480 |
| Provider Name | Zuzanna M Wieckowska |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902823743 PECOS PAC ID: 6901802545 Enrollment ID: I20061004000635 |
| Provider Name | Melissa S Defreest |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1407960388 PECOS PAC ID: 1850398884 Enrollment ID: I20061103000280 |
| Provider Name | Katherine L Beckstrand |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982676730 PECOS PAC ID: 7012052483 Enrollment ID: I20100310000245 |
| Provider Name | William R Macmaster |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164557054 PECOS PAC ID: 4688705130 Enrollment ID: I20100626000383 |
| Provider Name | Kristy L Kironde |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679895783 PECOS PAC ID: 7618160565 Enrollment ID: I20101022001281 |
| Provider Name | Juanita P Doerksen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679546162 PECOS PAC ID: 8820278120 Enrollment ID: I20110203000349 |
| Provider Name | Robert J Callahan |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1235392366 PECOS PAC ID: 8820268360 Enrollment ID: I20110819000174 |
| Provider Name | James E Sims |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467693093 PECOS PAC ID: 8628047172 Enrollment ID: I20111123000665 |
| Provider Name | Edgar Arturo Salazar Quiros |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386892263 PECOS PAC ID: 1355591777 Enrollment ID: I20121022000075 |
| Provider Name | Alba Virginia Schultz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801164926 PECOS PAC ID: 3173799392 Enrollment ID: I20131203001548 |
| Provider Name | Saman A Selahi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1174750335 PECOS PAC ID: 8224288295 Enrollment ID: I20140207001062 |
| Provider Name | Jennifer L Saxer |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1336130103 PECOS PAC ID: 7911080080 Enrollment ID: I20140429000440 |
| Provider Name | Rechelle L Asirot |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902118417 PECOS PAC ID: 1153546858 Enrollment ID: I20140714002492 |
| Provider Name | Leon E Mccook |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609175363 PECOS PAC ID: 3779715479 Enrollment ID: I20140731002735 |
| Provider Name | Sushanth Nayak |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710273958 PECOS PAC ID: 0648412627 Enrollment ID: I20140820002891 |
| Provider Name | Elizabeth A Mokrohisky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720195233 PECOS PAC ID: 9133153216 Enrollment ID: I20140905002040 |
| Provider Name | Rensie Chiara R De Vera |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477846608 PECOS PAC ID: 6507094364 Enrollment ID: I20140908000565 |
| Provider Name | Mary Jo A Laniewski |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1205918109 PECOS PAC ID: 9638112824 Enrollment ID: I20141103002406 |
| Provider Name | Clifton Burt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972824043 PECOS PAC ID: 7517191232 Enrollment ID: I20150707003456 |
| Provider Name | Andrea L Childress |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710211768 PECOS PAC ID: 0547308165 Enrollment ID: I20150820011704 |
| Provider Name | Micah Lundstedt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124428032 PECOS PAC ID: 3678880804 Enrollment ID: I20150921000387 |
| Provider Name | Erik W Young |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1891059333 PECOS PAC ID: 8325356785 Enrollment ID: I20151005000960 |
| Provider Name | Julie Ann A Galinato |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477816908 PECOS PAC ID: 8224347208 Enrollment ID: I20151013001525 |
| Provider Name | John M Malleis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144511643 PECOS PAC ID: 7315183910 Enrollment ID: I20151223000525 |
| Provider Name | Laura J Christensen |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1093176083 PECOS PAC ID: 5092013797 Enrollment ID: I20160413001403 |
| Provider Name | Joshua Nicholas Plank |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720342256 PECOS PAC ID: 7719125442 Enrollment ID: I20160505002372 |
| Provider Name | Linda F Mcintyre |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437510765 PECOS PAC ID: 9335438019 Enrollment ID: I20160519001077 |
| Provider Name | Marta E Hantke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508094442 PECOS PAC ID: 7012155385 Enrollment ID: I20160527001463 |
| Provider Name | Morgan C Garvin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1558676049 PECOS PAC ID: 7911148861 Enrollment ID: I20160707002497 |
| Provider Name | Rebecca Mcbride |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487044376 PECOS PAC ID: 7719208834 Enrollment ID: I20160811002731 |
| Provider Name | Leda Mae T Rabot Cura |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1154515781 PECOS PAC ID: 0143530840 Enrollment ID: I20161016000003 |
| Provider Name | Titus B Kosgei |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376099572 PECOS PAC ID: 9931487949 Enrollment ID: I20161026001283 |
| Provider Name | Samantha M Radel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548713399 PECOS PAC ID: 0941589493 Enrollment ID: I20161128001153 |
| Provider Name | Amy V Mann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760517098 PECOS PAC ID: 6507939634 Enrollment ID: I20161130000857 |
| Provider Name | Logan J Mcghan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689965204 PECOS PAC ID: 7113229865 Enrollment ID: I20170517000006 |
| Provider Name | Angela O Loveless |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508099433 PECOS PAC ID: 8628116043 Enrollment ID: I20170526000942 |
| Provider Name | Amber Vester |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942629126 PECOS PAC ID: 9638447410 Enrollment ID: I20170620001585 |
| Provider Name | Miranda D Lanning |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1609219989 PECOS PAC ID: 6406126804 Enrollment ID: I20170718001530 |
| Provider Name | Joanne M O'brien |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063507762 PECOS PAC ID: 3971591124 Enrollment ID: I20180316001655 |
| Provider Name | Monique Graves |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679851182 PECOS PAC ID: 6608135678 Enrollment ID: I20180402000862 |
| Provider Name | Ashley O Schmieding |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1871972141 PECOS PAC ID: 1951666734 Enrollment ID: I20180525002175 |
| Provider Name | Mark Schuchman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467517300 PECOS PAC ID: 2961683487 Enrollment ID: I20180531002299 |
| Provider Name | Devin Lee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790125649 PECOS PAC ID: 1052689163 Enrollment ID: I20180907000638 |
| Provider Name | Jennifer L Mitchell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508244260 PECOS PAC ID: 6608169354 Enrollment ID: I20181107001291 |
| Provider Name | Myra E Deline |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689149361 PECOS PAC ID: 5890030993 Enrollment ID: I20181218002164 |
| Provider Name | Mckinley M Hutchison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760961288 PECOS PAC ID: 3779828769 Enrollment ID: I20181219002301 |
| Provider Name | Kimberly R Stober |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942781489 PECOS PAC ID: 6204172414 Enrollment ID: I20190109001141 |
| Provider Name | Ossama Al Masalmeh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851654776 PECOS PAC ID: 0648571182 Enrollment ID: I20190620000506 |
| Provider Name | Rachel L Zubko |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578737342 PECOS PAC ID: 7012189889 Enrollment ID: I20190909003266 |
| Provider Name | Timothy P Landry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700340270 PECOS PAC ID: 3274967674 Enrollment ID: I20191217002915 |
| Provider Name | Jason S Vang-erickson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144780255 PECOS PAC ID: 7416383278 Enrollment ID: I20200214001508 |
| Provider Name | Inga Giske |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912471228 PECOS PAC ID: 1153752621 Enrollment ID: I20200518000683 |
| Provider Name | Emily M Griffith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083276307 PECOS PAC ID: 3678804176 Enrollment ID: I20210224002585 |
| Provider Name | Amy Marie Keech |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1639468697 PECOS PAC ID: 0749423630 Enrollment ID: I20210512003192 |
| Provider Name | Brian J Mccarthy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336461813 PECOS PAC ID: 3072644228 Enrollment ID: I20210524000565 |
| Provider Name | Arissa R Walberg |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891185286 PECOS PAC ID: 2062709660 Enrollment ID: I20210723003226 |
| Provider Name | Lily Mahala Cranor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760989487 PECOS PAC ID: 0840624029 Enrollment ID: I20210817002673 |
| Provider Name | Julie A Tenbrook |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164417606 PECOS PAC ID: 6709876279 Enrollment ID: I20220425002464 |
| Provider Name | Reena Baharani |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659631950 PECOS PAC ID: 5395018865 Enrollment ID: I20220803001505 |
| Provider Name | Sabo Uba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508106873 PECOS PAC ID: 4385889849 Enrollment ID: I20221003000681 |
| Provider Name | Maximilian Taylor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699206193 PECOS PAC ID: 4284961525 Enrollment ID: I20221017001868 |
| Provider Name | Audra Michelle Landry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770728701 PECOS PAC ID: 2062880438 Enrollment ID: I20221116002631 |
| Provider Name | Deirdre Sara Simpson-rhoads |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417496316 PECOS PAC ID: 8820453814 Enrollment ID: I20230426001519 |
| Provider Name | Genevieve Murstig |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1285245696 PECOS PAC ID: 1850757048 Enrollment ID: I20230512001847 |
| Provider Name | Donald Pierce |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1790197523 PECOS PAC ID: 4880811264 Enrollment ID: I20230517002436 |
| Provider Name | Janette Leal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992090708 PECOS PAC ID: 4981844305 Enrollment ID: I20230523002747 |
| Provider Name | Kodjovi D Kodjo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780100958 PECOS PAC ID: 7517203177 Enrollment ID: I20230607001792 |
| Provider Name | Ashley Le Compte Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205520244 PECOS PAC ID: 4486012895 Enrollment ID: I20230616000872 |
| Provider Name | Bret Gorham |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1841797032 PECOS PAC ID: 3375965338 Enrollment ID: I20230616001502 |
| Provider Name | Chalapathi Rao Medavarapu |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1750876868 PECOS PAC ID: 8325407547 Enrollment ID: I20230706002832 |
| Provider Name | Phillip Bonar |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487271219 PECOS PAC ID: 8123494473 Enrollment ID: I20230809001826 |
| Provider Name | Jose Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669086641 PECOS PAC ID: 4183043383 Enrollment ID: I20230824002628 |
| Provider Name | Yulia V Kotlyar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033605415 PECOS PAC ID: 9739503012 Enrollment ID: I20231004002370 |
| Provider Name | Camille Claire Rain |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346891603 PECOS PAC ID: 7012330400 Enrollment ID: I20240518000421 |
| Provider Name | Ian Dobbe |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1710337381 PECOS PAC ID: 0143554394 Enrollment ID: I20240823001218 |
| Provider Name | Sandra O Kolapo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568834984 PECOS PAC ID: 1052605680 Enrollment ID: I20241213002962 |
| Provider Name | Tammy Wiscovitch |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1891501748 PECOS PAC ID: 6709315492 Enrollment ID: I20250124002125 |
| Provider Name | Solange Marcel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679602536 PECOS PAC ID: 9335200153 Enrollment ID: I20250217003009 |
| Provider Name | Robert Kenneth Gillespie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386454353 PECOS PAC ID: 1759806334 Enrollment ID: I20250416000823 |
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