NPIMap

Organization Active NPI

Columbia Lutheran Charities

Doing business as CMH Astoria Primary Care Clinic

  • Rural Health Clinic/Center
  • Astoria, OR
National Provider Identifier
1093294571
Registry record updated Aug 13, 2018
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 Astoria Primary Care Clinic
Columbia Memorial Hospital
Practice address
2158 Exchange St Ste 107
Astoria, OR 97103
Phone
(503) 338-4675
Fax
(503) 338-4676
NPI assigned
Aug 7, 2018
Last updated
Aug 13, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2018

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

Authorized official

Name
Kimberly Kae Thomas
Title
Revenue Cycle Director
Phone
(503) 338-4027

Specialties & licenses 1

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

Addresses

Primary practice location

2158 Exchange St Ste 107
Astoria, OR 97103

Mailing address

2111 Exchange St
Astoria, OR 97103-3329
Phone (503) 325-4321

Other names 2

  • CMH Astoria Primary Care Clinic Doing business as
  • Columbia Memorial Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181010002985 OR Part A Provider - Rural Health Clinic 5294643359 Practice locations: Astoria, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093294571. Details of each certification follow.

Rural health clinic certification: CCN 388543

Legal name
COLUMBIA LUTHERAN CHARITIES
Doing business as
CMH ASTORIA PRIMARY CARE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 18, 2018
Last certification
Dec 16, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Oct 18, 1958 in OR
Enrollment address
2158 Exchange St
Ste 107
Astoria, OR 97103-3316
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 Lutheran Charities13 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 15

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 5%
Doug Kaup Individual Corporate OfficerBoard Member Dec 1, 2016
Matthew Phillips Individual Corporate DirectorBoard Member Nov 5, 2020 5%
Erik W Thorsen Individual Corporate Officer Jan 1, 2010 5%
W-2 Managing EmployeeCeo Jan 1, 2010 50%
David Nygaard Individual Corporate DirectorBoard Member Dec 31, 2016 5%
Constance Carol Waisanen Individual Corporate DirectorBoard Member Mar 5, 1999
Mike Autio Individual Corporate Director Apr 12, 2018
Brian D Duty Individual Corporate DirectorBoard Member Apr 3, 2025
Heather Ann Seppa Individual Corporate OfficerBoard Member Nov 1, 2007
Regina C. Mysliwiec Individual Corporate DirectorBoard Member Jan 1, 2025
Nancy R McAllister Individual Corporate DirectorBoard Member Apr 23, 1992 5%
Aaron a Brown Individual W-2 Managing EmployeeMD; Jan 1, 2024
Nicole L Williams Individual Corporate Officer Feb 11, 2018 5%
William Walter Landwehr Individual Corporate DirectorBoard Member Jan 8, 2009

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": "1533600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534118400000",
    "number": "1093294571",
    "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": "503-325-4321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2158 EXCHANGE ST STE 107",
            "city": "ASTORIA",
            "state": "OR",
            "postal_code": "97103",
            "telephone_number": "503-338-4675",
            "fax_number": "503-338-4676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA LUTHERAN CHARITIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-07",
        "last_updated": "2018-08-13",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "KAE",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "503-338-4027"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CMH Astoria Primary Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Columbia Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Astoria, OR

Sources for this page

Verify at the official NPI Registry.