NPIMap

Organization Active NPI

Columbia Lutheran Charities

Doing business as CMH Primary Care Clinic

  • Rural Health Clinic/Center
  • Warrenton, OR
National Provider Identifier
1033469663
Registry record updated Aug 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COLUMBIA LUTHERAN CHARITIES
Doing business as
CMH Primary Care Clinic
Practice address
1639 SE Ensign LN
Suite B103
Warrenton, OR 97146-7308
Phone
(503) 338-4500
Fax
(503) 338-4501
NPI assigned
Sep 11, 2012
Last updated
Aug 6, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Stephanie Brenden
Title
Cfo
Phone
(503) 325-4321

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1639 SE Ensign LN
Suite B103
Warrenton, OR 97146-7308

Mailing address

2111 Exchange St
Astoria, OR 97103-3329
Phone (503) 338-4500

Other names 1

  • CMH Primary Care Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130711000616 OR Part A Provider - Rural Health Clinic 5294643359 Practice locations: Warrenton, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033469663. Details of each certification follow.

Rural health clinic certification: CCN 388515

Legal name
COLUMBIA LUTHERAN CHARITIES
Doing business as
CMH PRIMARY CARE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 4, 2014
Last certification
Oct 16, 2020
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Oct 18, 1958 in OR
Enrollment address
1639 SE Ensign LN Ste B102-B103
Warrenton, OR 97146-7308
Related CCNs
381320

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Columbia Memorial Hospi13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 16

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Paul Haines Individual Corporate DirectorBoard Member Nov 5, 2020 5%
Patricia J Danforth Individual Corporate DirectorBoard Member Dec 1, 2016
Doug Kaup Individual Corporate OfficerBoard Member Dec 1, 2016
Matthew Phillips Individual Corporate DirectorBoard Member Nov 5, 2020 5%
Erik W Thorsen Individual Corporate OfficerCeo Jan 1, 2010 5%
W-2 Managing EmployeeCeo Jan 1, 2010 50%
Robert L Holland Individual Corporate Director Dec 5, 2013
David Nygaard Individual Corporate DirectorBoard Member Dec 31, 2016 5%
Constance Carol Waisanen Individual Corporate DirectorBoard Member Mar 5, 2009
Mike Autio Individual Corporate Director Apr 12, 2018
Quratulain Durrani Individual Corporate DirectorBoard Member Aug 15, 2022
James a Heilman Individual Corporate DirectorBoard Member May 2, 2019 5%
Heather Ann Seppa Individual Corporate DirectorBoard Member Nov 1, 2007
Nancy R McAllister Individual Corporate DirectorBoard Member Apr 23, 1992 5%
Nicole L Williams Individual Corporate OfficerCoo Feb 11, 2018 5%
William Walter Landwehr Individual Corporate DirectorBoard Member Jan 8, 2009
Jennifer Brown Individual W-2 Managing EmployeeMD; Jan 1, 2024

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lower Columbia HospiceAstoria, OR, CCN 381520 Hospice 5% Or Greater Direct Ownership Interest May 22, 1991

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438819200000",
    "number": "1033469663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 EXCHANGE ST",
            "city": "ASTORIA",
            "state": "OR",
            "postal_code": "971033329",
            "telephone_number": "503-338-4500",
            "fax_number": "503-338-4501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1639 SE ENSIGN LN",
            "address_2": "SUITE B103",
            "city": "WARRENTON",
            "state": "OR",
            "postal_code": "971467308",
            "telephone_number": "503-338-4500",
            "fax_number": "503-338-4501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA LUTHERAN CHARITIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-11",
        "last_updated": "2015-08-06",
        "status": "A",
        "authorized_official_last_name": "BRENDEN",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "503-325-4321",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CMH Primary Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Warrenton, OR

Sources for this page

Verify at the official NPI Registry.