NPIMap

Organization Active NPI

Bywater Health, LLC

  • Primary Care Clinic/Center
  • Portland, OR
National Provider Identifier
1356192652
Registry record updated Dec 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
BYWATER HEALTH, LLC
Practice address
2119 NE Halsey St
Portland, OR 97232-1522
Phone
(503) 975-9398
Fax
(503) 221-8320
NPI assigned
Mar 27, 2024
Last updated
Dec 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2024

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

Authorized official

Name
Charles Eugene Williamson, NPNPI 1740446335
Title
Owner
Phone
(504) 434-9164

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X NU
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

2119 NE Halsey St
Portland, OR 97232-1522

Mailing address

2119 NE Halsey St
Portland, OR 97232-1522
Phone (503) 975-9398

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2307111Bywater Health, LLC2119 NE Halsey Street, Portland, OR 97232Certificate of waiverJun 30, 2028

National Provider Directory

National Provider Directory

Locations

1923 NE Broadway St
Unit 8
Portland, OR 97232

Interoperability endpoints

  • Direct secure messaging: charleswilliamson@org211.direct.charmhealth.com

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": "1711497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735516800000",
    "number": "1356192652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2119 NE HALSEY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321522",
            "telephone_number": "503-975-9398",
            "fax_number": "503-221-8320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2119 NE HALSEY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321522",
            "telephone_number": "503-975-9398",
            "fax_number": "503-221-8320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BYWATER HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-27",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A",
        "authorized_official_last_name": "WILLIAMSON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-434-9164",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.