NPIMap

Organization Active NPI

Confederated Tribes of Siletz

  • Federally Qualified Health Center (FQHC)
  • Siletz, OR
National Provider Identifier
1316040249
Registry record updated Sep 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
169841 Issued in OR
Legal business name
CONFEDERATED TRIBES OF SILETZ
Doing business as
Siletz Community Health Clinic
Practice address
200 Gwee-Shut Rd
Siletz, OR 97380-2036
Phone
(541) 444-1030
Fax
(541) 444-9695
NPI assigned
Sep 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2022

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

Authorized official

Name
Miranda Williams
Title
Health Director
Phone
(541) 444-1030

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Federally Qualified Health Center (FQHC) 261QF0400X 169841 OR Primary

Addresses

Primary practice location

200 Gwee-Shut Rd
Siletz, OR 97380-2036

Mailing address

PO Box 320
Siletz, OR 97380-0320
Phone (541) 444-1030

Other identifiers 1

IdentifierTypeStateIssuer
169841MedicaidOR

Other names 1

  • Siletz Community Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040204000309 OR Part B Supplier - Clinic/Group Practice 6204729288 Receives reassigned benefits from 14 practitioners
1 other NPI on this enrollment
Practice locations: Lincoln City, OR; Siletz, OR
O20250429000096 OR Part A Provider - Federally Qualified Health Center (FQHC) 6204729288 Practice locations: Siletz, OR

Federally qualified health center certification: CCN 381049

Legal name
CONFEDERATED TRIBES OF SILETZ
Doing business as
SILETZ COMMUNITY HEALTH CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 22, 2025
Last certification
Apr 22, 2025
Ownership / control type
For profit – corporation
Organization structure
GovernmentProprietary
Enrollment address
200 Gwee Shut Rd
Siletz, OR 97380-2036

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Confederated Tribes of3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Kurtis Barker Individual Corporate OfficerChief Executive Officer Feb 1, 2022 100%
Operational/Managerial ControlChief Executive Officer Feb 1, 2022 100%
Confederated Tribes of Siletz Organization, Siletz, OR Medical provider/supplier 5% Or Greater Direct Ownership Interest Jan 1, 2007 100%

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663718400000",
    "number": "1316040249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 320",
            "city": "SILETZ",
            "state": "OR",
            "postal_code": "973800320",
            "telephone_number": "541-444-1030",
            "fax_number": "541-444-9695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 GWEE-SHUT RD",
            "city": "SILETZ",
            "state": "OR",
            "postal_code": "973802036",
            "telephone_number": "541-444-1030",
            "fax_number": "541-444-9695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONFEDERATED TRIBES OF SILETZ",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-06",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "MIRANDA",
        "authorized_official_title_or_position": "HEALTH DIRECTOR",
        "authorized_official_telephone_number": "541-444-1030"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "OR",
            "license": "169841",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "169841",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Siletz Community Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Siletz, OR

Sources for this page

Verify at the official NPI Registry.