Canyon Creek Clinic

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

CANYON CREEK CLINIC

Practice address

235 S Canyon Blvd
John Day, OR 97845-1044

Phone

(541) 575-1263

Fax

(541) 575-0233

NPI assigned

Aug 14, 2020

Organization subpart

No

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

Authorized official

Name

Shawna Clark, FNPNPI 1962798793

Title

President

Phone

(541) 575-1263

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

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

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/22399/brand/1/csg/1/fhir/r4

Practitioners 1

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

• Shawna A Clark, DNP, FNP

  • Family Nurse Practitioner
  • John Day, OR
  • NPI 1962798793

  OR

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1597363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624320000000",
    "number": "1356952048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 S CANYON BLVD",
            "city": "JOHN DAY",
            "state": "OR",
            "postal_code": "978451044",
            "telephone_number": "541-575-1263",
            "fax_number": "541-575-0233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 S CANYON BLVD",
            "city": "JOHN DAY",
            "state": "OR",
            "postal_code": "978451044",
            "telephone_number": "541-575-1263",
            "fax_number": "541-575-0233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON CREEK CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-14",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "SHAWNA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-575-1263",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Shawna.Clark.1@22399.direct.AthenaHealth.com",
            "affiliation": "Y",
            "endpointDescription": "CCC for Shawna",
            "affiliationName": "Canyon Creek Clinic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "235 S Canyon Blvd",
            "city": "John Day",
            "state": "OR",
            "country_code": "US",
            "postal_code": "978451044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Laura Brunton
• Robert James Henry Bryant II, QMHA
• James Edward Calhoon, RPH
• Amelia Kathleen Cancilla, DTTAC LIFESTYLE COAC
• Canyon Creek Chic LLC
• Margo Lynn Cartwright, QMHP
• Charles Andrew Caughlin, DC
• Kent Cherry
• Russell M Clark
• Shawna A Clark, DNP, FNP

• All providers in John Day, OR
• Primary Care Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.