NPIMap

Organization Active NPI

Winding Waters Clinic PC

  • Rural Health Clinic/Center
  • Enterprise, OR
National Provider Identifier
1053304394
Registry record updated Jun 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
383864 Issued in OR
Legal business name
WINDING WATERS CLINIC PC
Practice address
603 Medical Pkwy
Enterprise, OR 97828-5124
Phone
(541) 426-4502
Fax
(541) 426-6403
NPI assigned
Aug 23, 2005
Last updated
Jun 29, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2015

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

Authorized official

Name
Dr. Renee E Grandi, MDNPI 1356334601
Title
Pres
Phone
(541) 426-4502

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Rural Health Clinic/Center 261QR1300X 383864 OR Primary

Addresses

Primary practice location

603 Medical Pkwy
Enterprise, OR 97828-5124

Mailing address

603 Medical Pkwy
Enterprise, OR 97828-5124
Phone (541) 426-4502

Other identifiers 3

IdentifierTypeStateIssuer
OR01145OtherORMEDICARE EMC SUBMITTER
223198MedicaidOR
CG2920OtherORRAILROAD MEDICARE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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": "1124755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435536000000",
    "number": "1053304394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 MEDICAL PKWY",
            "city": "ENTERPRISE",
            "state": "OR",
            "postal_code": "978285124",
            "telephone_number": "541-426-4502",
            "fax_number": "541-426-6403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 MEDICAL PKWY",
            "city": "ENTERPRISE",
            "state": "OR",
            "postal_code": "978285124",
            "telephone_number": "541-426-4502",
            "fax_number": "541-426-6403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINDING WATERS CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-23",
        "last_updated": "2015-06-29",
        "status": "A",
        "authorized_official_last_name": "GRANDI",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRES",
        "authorized_official_telephone_number": "541-426-4502",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "OR",
            "license": "383864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE EMC SUBMITTER",
            "identifier": "OR01145",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "223198",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CG2920",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Enterprise, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.