Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

PACIFICSOURCE PACE, LLC
NPI 1104787704
Program of All-Inclusive Care for the Elderly (PACE) Provider Organization in Springfield, OR

Q: What is Pacificsource Pace, LLC's NPI number?

The NPI number for Pacificsource Pace, LLC is 1104787704. It was assigned to this organization in the NPPES registry on November 21, 2025.

Q: What is Pacificsource Pace, LLC's specialty?

The primary specialty registered for this NPI is Program of All-Inclusive Care for the Elderly (PACE) Provider Organization with taxonomy code 251T00000X.

Active since November 21, 2025CLIA 38D2327448 · Waiver

555 INTERNATIONAL WAY STE B104, SPRINGFIELD, OR 97477(458) 544-0400 Get Directions Write a Review

NPPES record last updated: July 16, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 16, 2026, Apr 27, 2026, Apr 14, 2026 and 1 more (4 updates tracked since 2025).

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About Pacificsource Pace, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PACIFICSOURCE PACE, LLC (NPI 1104787704) is a healthcare organization registered as a program of all-inclusive care for the elderly (pace) provider organization in Springfield, Oregon and active in the NPI registry since November 2025. The organization holds a CLIA Waiver certificate valid through July 21, 2027 and lists Kristin Kernutt, Chief Legal Counsel, as its authorized official.

NPPES Registry Identity

NPI1104787704

Entity TypeOrganization

Primary Taxonomy251T00000X

Legal Business NamePACIFICSOURCE PACE, LLC

Location Address555 INTERNATIONAL WAY STE B104Springfield, OR 97477-6013

Mailing Address555 International Way Ste B104Springfield, OR 97477-6013 · (458) 544-0400 · Fax (541) 255-2797

Phone(458) 544-0400

Organization SubpartNo

Authorized OfficialKristin KernuttChief Legal Counsel · (541) 225-1967

Enumeration DateNovember 21, 2025

Last NPPES UpdateJuly 16, 20264 updates tracked since enumeration

NPPES CertifiedJuly 16, 2026

✔ NPI 1104787704 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyProgram of All-Inclusive Care for the Elderly (PACE) Provider OrganizationAgencies

Taxonomy Code251T00000X

Definition

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.

555 INTERNATIONAL WAY STE B104, Springfield, OR 97477

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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 38D2327448

Pacificsource Pace, LLC · Springfield, OR

Active · expires Jul 21, 2027

CLIA Number38D2327448

Laboratory TypePace Center

Certificate Effective DateJuly 22, 2025

Certificate Expiration DateJuly 21, 2027

Laboratory DirectorJessica Van Fleet-Green

Laboratory Phone(458) 544-0400

Laboratory LocationPacificsource Pace, LLC555 International Way, B104, Springfield, OR 97477

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pacificsource Pace, LLC's NPI number?

The NPI number for Pacificsource Pace, LLC is 1104787704. It was assigned to this organization in the NPPES registry on November 21, 2025.

Where is Pacificsource Pace, LLC located?

Pacificsource Pace, LLC is located at 555 International Way Ste B104, Springfield, OR 97477. The listed phone number is (458) 544-0400.

What is Pacificsource Pace, LLC's specialty?

The primary specialty registered for this NPI is Program of All-Inclusive Care for the Elderly (PACE) Provider Organization with taxonomy code 251T00000X.

Does Pacificsource Pace, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 38D2327448) is associated with this NPI, valid through July 21, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Pacificsource Pace, LLC was last updated on July 16, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.