Pacificsource Pace, LLC
PACE Provider Organization in Springfield, OR. Organization (NPI-2).
NPI number1104787704
StatusActive
Last updated in NPPESJul 16, 2026
Details
- NPI
- 1104787704
- Entity type
- Organization (NPI-2)
- Legal business name
- Pacificsource Pace, LLC
- Organization subpart
- No
- Enumeration date
- Nov 21, 2025
- Certification date
- Jul 16, 2026
- Last updated
- Jul 16, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251T00000X | PACE Provider Organization | – | – | Yes |
Practice location
555 International Way Ste B104Springfield, OR 97477-6013
Phone 458-544-0400
Mailing address
555 International Way Ste B104Springfield, OR 97477-6013
Phone 458-544-0400 · Fax 541-255-2797
Authorized official
Kristin Kernutt
Chief Legal Counsel
5412251967
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