PACIFICSOURCE PACE, LLC
NPI 1104787704
Program of All-Inclusive Care for the Elderly (PACE) Provider Organization in Springfield, OR
NPI Status: Active since November 21, 2025
Contact Information
555 INTERNATIONAL WAY STE B104
SPRINGFIELD, OR
ZIP 97477
Phone: (425) 214-2526
- Organization
- Program of All-Inclusive Care for the El...
- CLIA Number: 38D2327448
- CLIA Cert. Type: Other - PACE CENTER
- CLIA Exp. Date: 07-21-2027
About PACIFICSOURCE PACE, LLC
This page provides the complete NPI Profile along with additional information for Pacificsource Pace, Llc, a provider established in Springfield, Oregon operating as a Program Of All-inclusive Care For The Elderly (pace) Provider Organization. The healthcare provider is registered in the NPI registry with number 1104787704 assigned on November 2025. The practitioner's primary taxonomy code is 251T00000X. The provider is registered as an organization and their NPI record was last updated April 2026. The authorized official of this NPI record is Kristin Kernutt Jd (Chief Legal Counsel)
- NPI
- 1104787704
- Provider Name
- PACIFICSOURCE PACE, LLC
- Entity Type
- Organization
- Location Address
- 555 INTERNATIONAL WAY STE B104 SPRINGFIELD, OR 97477
- Location Phone
- (425) 214-2526
- Mailing Address
- 555 INTERNATIONAL WAY STE B104 SPRINGFIELD, OR 97477
- Mailing Phone
- (425) 214-2526
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 11-21-2025
- Last Update Date
- 04-27-2026
- 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
Program of All-Inclusive Care for the Elderly (PACE) Provider Organization
- Taxonomy Code
- 251T00000X
- Type
- Agencies
- Taxonomy Description
- A PACE provider organization is a not-for-profit private or public entity that is primarily engaged in providing PACE services(unique capitated managed care benefits for the frail elderly which include comprehensive medical and social services). The following characteristics also apply to a PACE organization. It must: have a governing board that includes community representation; be able to provide complete PACE services regardless of frequency or duration of services; have a physical site to provide adult day services; have a defined service area; have safeguards against conflict of interest; have demonstrated fiscal soundness and have a formal Participant Bill of Rights.
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
- 38D2327448
- Facility Type
- Other - PACE CENTER
- Certificate Effective Date
- July 22, 2025
- Certificate Expiration Date
- July 21, 2027
- Laboratory Director
- JESSICA VAN FLEET-GREEN
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Pacificsource Pace, Llc 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 NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1104787704, we treat the final digit (4) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 56. The final step is to find the difference between that total and the next multiple of ten (60 - 56 = 4).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 56 is 60. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1104787704, enumerated as an "organization" on November 21, 2025.
The provider is located at 555 INTERNATIONAL WAY STE B104 SPRINGFIELD, OR 97477 and the phone number is (425) 214-2526.
Program of All-Inclusive Care for the Elderly (PACE) Provider Organization with taxonomy code 251T00000X.
