NPIMap

Organization Active NPI

St. Charles Health System, Inc.

Doing business as St. Charles Family Care - Prineville

  • Rural Health Clinic/Center
  • Prineville, OR
National Provider Identifier
1407178528
Registry record updated May 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ST. CHARLES HEALTH SYSTEM, INC.
Doing business as
St. Charles Family Care - Prineville
Practice address
384 SE Combs Flat Rd
Suite 1200
Prineville, OR 97754-2562
Phone
(541) 447-6263
Fax
(541) 447-8724
NPI assigned
Feb 16, 2010
Last updated
May 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2023

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

Authorized official

Name
Matthew Swafford
Title
Cfo
Phone
(541) 382-4321

Specialties & licenses 1

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

Addresses

Primary practice location

384 SE Combs Flat Rd
Suite 1200
Prineville, OR 97754-2562

Mailing address

PO Box 6095
Bend, OR 97708-6095
Phone (541) 382-4321

Other identifiers 1

IdentifierTypeStateIssuer
500642552MedicaidOR

Other names 1

  • St. Charles Family Care - Prineville Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040112000045 OR Part B Supplier - Clinic/Group Practice 3870402852 Receives reassigned benefits from 349 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bend, OR; Sisters, OR; Redmond, OR; Prineville, OR; Madras, OR; La Pine, OR
O20100527000810 OR Part A Provider - Rural Health Clinic 3870402852 Practice locations: Prineville, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407178528. Details of each certification follow.

Rural health clinic certification: CCN 388505

Legal name
ST CHARLES HEALTH SYSTEM INC
Doing business as
ST. CHARLES FAMILY CARE-PRINEVILLE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 1, 2011
Last certification
Jun 11, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Dec 8, 1971 in OR
Enrollment address
384 SE Combs Flat Rd 1200
Prineville, OR 97754-2562
Related CCNs
381313

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory

Locations

29358 Network Pl
Chicago, IL 60673

2600 NE Neff Rd
Bend, OR 97701
Phone (541) 706-3700

360 SW Bond St
Bend, OR 97702
Phone (541) 706-7730

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Shelly Handkins Individual Corporate Director Jan 1, 2021
Steven G Gordon Individual Corporate OfficerChief Executive Officer Jul 20, 2022
Corporate DirectorBoard Member Sep 1, 2014
W-2 Managing Employee Jul 20, 2022
Matthew Swafford Individual Corporate OfficerCfo Aug 1, 2021
Jenny Obrien Individual Corporate Director Jan 1, 2021
James Orlikoff Individual Corporate DirectorBoard Member Jan 1, 2018
Ann Rhoads Individual Corporate Director Jan 1, 2021
St Charles Health System Inc Organization, Bend, OR 5% Or Greater Direct Ownership Interest Apr 1, 2010 100%
Jennifer Schmid Individual Corporate Director Aug 1, 2019
John M Terhes Individual Corporate Director Aug 1, 2019
Jarvis Sam Individual Corporate Director Jan 1, 2021

Owners & managing parties with NPI records 10

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 8

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
St. Charles Bend CampusBend, OR, CCN 380047 Hospital Operational/Managerial Control (100%) Jan 1, 2016
St. Charles BendBend, OR, CCN 38T047 Hospital Operational/Managerial Control (100%) Jan 1, 2001
Sage View at St CharlesBend, OR, CCN 38S047 Hospital Operational/Managerial Control Mar 23, 2005
St. Charles PrinevillePrineville, OR, CCN 381313 Hospital Operational/Managerial Control (100%) Jan 1, 2008
St. Charles - MadrasMadras, OR, CCN 381324 Hospital Operational/Managerial Control Jan 1, 2013
St. Charles - MadrasMadras, OR, CCN 38Z324 Hospital Operational/Managerial Control Jan 1, 2013
St. Charles Home Health ServicesBend, OR, CCN 387026 Home health agency 5% Or Greater Direct Ownership Interest (100%) Aug 5, 1966
St Charles HospiceBend, OR, CCN 381509 Hospice Operational/Managerial Control Jan 1, 2008

Owned or controlled facilities with NPI records 12

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 8

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 156

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.

View all 156

NPI Registry JSON

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

{
    "created_epoch": "1266278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683244800000",
    "number": "1407178528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6095",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977086095",
            "telephone_number": "541-382-4321",
            "fax_number": "541-447-8724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "384 SE COMBS FLAT RD",
            "address_2": "SUITE 1200",
            "city": "PRINEVILLE",
            "state": "OR",
            "postal_code": "977542562",
            "telephone_number": "541-447-6263",
            "fax_number": "541-447-8724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CHARLES HEALTH SYSTEM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-16",
        "last_updated": "2023-05-05",
        "certification_date": "2023-05-05",
        "status": "A",
        "authorized_official_last_name": "SWAFFORD",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "541-382-4321"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500642552",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "St. Charles Family Care - Prineville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Charles Family Care - Prineville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prineville, OR

Sources for this page

Verify at the official NPI Registry.