Columbia Lutheran Charities
Organization Active NPI Rural Health Clinic/Center · Warrenton, OR
NPI 1033469663 · NPPES record last updated Aug 6, 2015
Key facts
- NPI
- 1033469663
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- COLUMBIA LUTHERAN CHARITIES
- 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
- Organization subpart
- No
Authorized official
- Name
- Mrs. Stephanie Brenden
- Title
- Cfo
- Phone
- (503) 325-4321
Owners & managing parties with NPI records 3
-
Jennifer Marie Brown, M.D.
-
James A Heilman, M.D.
-
Quratulain Durrani, M.D.
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 12
Related certifications (CCN) 5
Practitioners 112
-
Douglas D Abbott, M.D.
-
Grecori Anderson, MD
-
Adam Lloyd Bingham, D.P.M
-
Aaron Andrew Brown, D.O
-
Jennifer Marie Brown, M.D.
-
Keri Kay Brown, D.O.
-
Andrew J Bryan, MD
-
Dave A Cantrell, PA-C
-
Gagandeep Choudhary, MBBS
-
Jonathan Crandall, CRNA
-
Kristianna E Daniels, PA-C
-
Tyesha Dawn Marie Dent, PA-C
-
Jon E Ekstrom, MD
-
Tonya Frederick, RN, FNP
-
Olga R Garcia, D.O.
-
Danielle Rene Glover-Cloutier, BSN, DNP, NP-C
-
Amanda Jeanne Grant, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
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
- Corporation · Non-profit
- Incorporated
- Oct 18, 1958 in OR
- Enrollment address
- 1639 SE Ensign LN Ste B102-B103
Warrenton, OR 97146-7308 - Related CCNs
- 381320
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Paul Haines |
Corporate Director |
Nov 5, 2020 | 5% |
| Patricia J Danforth |
Corporate Director |
Dec 1, 2016 | |
| Doug Kaup |
Corporate Officer |
Dec 1, 2016 | |
| Matthew Phillips |
Corporate Director |
Nov 5, 2020 | 5% |
| Erik W Thorsen |
Corporate Officer |
Jan 1, 2010 | 5% |
| W-2 Managing Employee |
Jan 1, 2010 | 50% | |
| Robert L Holland |
Corporate Director | Dec 5, 2013 | |
| David Nygaard |
Corporate Director |
Dec 31, 2016 | 5% |
| Constance Carol Waisanen |
Corporate Director |
Mar 5, 2009 | |
| Mike Autio |
Corporate Director | Apr 12, 2018 | |
| Quratulain Durrani |
Corporate Director |
Aug 15, 2022 | |
| James a Heilman |
Corporate Director |
May 2, 2019 | 5% |
| Heather Ann Seppa |
Corporate Director |
Nov 1, 2007 | |
| Nancy R McAllister |
Corporate Director |
Apr 23, 1992 | 5% |
| Nicole L Williams |
Corporate Officer |
Feb 11, 2018 | 5% |
| William Walter Landwehr |
Corporate Director |
Jan 8, 2009 | |
| Jennifer Brown |
W-2 Managing Employee |
Jan 1, 2024 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Lower Columbia Hospice |
Hospice | 5% Or Greater Direct Ownership Interest | May 22, 1991 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130711000616 | OR | Part a Provider - Rural Health Clinic | 5294643359 | Practice locations: Warrenton, OR |
National Provider Directory
- Tax ID family
- Dennis Winner
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 388515 | Other | OR | MEDICARE PTAN |
Other names
- CMH Primary Care Clinic
Other providers in Warrenton, OR
- Clatsop Behavioral Healthcare
- Clatsop Behavioral Healthcare
- Kansys Clouse
- Coast Rehabilitation Services
- Alison Coffinbarger
- Columbian Lutheran Charities
- Kimberley Lucile Combs
- Sean Joseph Compton
- Rebekah Marlene Connelly
- Sarah Conyers
All providers in Warrenton, OR · Rural Health Clinic/Center in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.