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EARTH SOURCE MEDICINE
NPI 1164952495
Clinic/Center in Astoria, OR

Active since June 19, 2017
757 W MARINE DR STE 103, ASTORIA, OR 97103(207) 209-4858(207) 405-2199 Get Directions Write a Review

NPPES record last updated: April 21, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 21, 2026, Jul 6, 2021, Mar 17, 2018 and 1 more (4 updates tracked since 2017).

About Earth Source Medicine NPPES

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

EARTH SOURCE MEDICINE (NPI 1164952495), doing business as Astoria Integrative Family Medicine, is a healthcare organization registered as a clinic/center in Astoria, Oregon and active in the NPI registry since June 2017. The organization maintains a secondary practice location in Portland and lists Carolyn Iacullo Nygaard, Owner, as its authorized official.

NPPES Registry Identity

NPI1164952495
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameEARTH SOURCE MEDICINE
Location Address757 W MARINE DR STE 103Astoria, OR 97103-5848
Mailing Address757 W Marine Dr Ste 103Astoria, OR 97103-5848 · (207) 209-4858 · Fax (207) 405-2199
Phone(207) 209-4858
Fax(207) 405-2199
Organization SubpartNo
Authorized OfficialCarolyn Iacullo NygaardOwner · (207) 209-4858
Enumeration DateJune 19, 2017
Last NPPES UpdateApril 21, 20264 updates tracked since enumeration
NPPES CertifiedApril 21, 2026
✔ NPI 1164952495 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
757 W MARINE DR STE 103, Astoria, OR 97103
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Other Names 2

Doing Business AsAstoria Integrative Family Medicine
Doing Business AsNaturopathic By Design

Secondary Practice Location 1

Location 1254 Commercial St Ste 258Portland, ME 04101-4664 · Phone (207) 209-4858 · Fax (207) 405-2199

Other Identifiers 1

Medicaid500642404OR

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc..Insurance ›

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CAROLYN IACULLO NYGAARD N.D
Naturopath
757 W MARINE DR STE 103
ASTORIA, OR 97103
Clatsop County (207) 209-4858

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 Earth Source Medicine's NPI number?

The NPI number for Earth Source Medicine is 1164952495. It was assigned to this organization in the NPPES registry on June 19, 2017. The provider is doing business as Astoria Integrative Family Medicine and Naturopathic By Design.

Where is Earth Source Medicine located?

Earth Source Medicine is located at 757 W Marine Dr Ste 103, Astoria, OR 97103. The listed phone number is (207) 209-4858.

What is Earth Source Medicine's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

What insurance does Earth Source Medicine accept?

Health plans from Moda Health Plan, Inc. list Earth Source Medicine as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Earth Source Medicine was last updated on April 21, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months 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.