NPIMap

Organization Active NPI

South Gilliam County Health Dist

Doing business as South Gilliam Health Center

  • Rural Health Clinic/Center
  • Condon, OR
National Provider Identifier
1588964407
Registry record updated Dec 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SOUTH GILLIAM COUNTY HEALTH DIST
Doing business as
South Gilliam Health Center
Practice address
422 North Main St.
Condon, OR 97823
Phone
(541) 384-2061
NPI assigned
Oct 26, 2010
Last updated
Dec 30, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2021

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

Authorized official

Name
Mrs. Cynthia K.F. Hinton
Title
Board Chairman
Phone
(541) 384-2061

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X
Primary Care Clinic/Center 261QP2300X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

422 North Main St.
Condon, OR 97823

Mailing address

422 North Main St.
Condon, OR 97823
Phone (541) 384-2061

Other names 1

  • South Gilliam Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110726000507 OR Part A Provider - Rural Health Clinic 6204914005 Practice locations: Condon, OR
O20111202000488 OR Part B Supplier - Clinic/Group Practice 6204914005 Receives reassigned benefits from 3 practitioners
Practice locations: Condon, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1588964407. Details of each certification follow.

Rural health clinic certification: CCN 383805

Legal name
SOUTH GILLIAM COUNTY HEALTH DIST
Doing business as
SOUTH GILLIAM HEALTH CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 12, 1980
Last certification
Apr 25, 2024
Ownership / control type
2B
Most recent change of ownership
Jan 5, 2011 (1 total)
Organization structure
GovernmentProprietary
Enrollment address
422 N Main St
Condon, OR 97823-7651

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
38D0628563South Gilliam Health Center422 N Main St, Condon, OR 97823Provider-performed microscopyFeb 19, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Cynthia Hinton Individual Corporate Director Jun 10, 2011
Rene Durfey Individual Corporate Director Jun 10, 2011
Paul Bates Individual Corporate Director Jun 10, 2011
Hollie Winslow Individual W-2 Managing Employee Jun 10, 2011

Practitioners & affiliated clinicians

Practitioners 5

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": "1288051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640822400000",
    "number": "1588964407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "422 NORTH MAIN ST.",
            "city": "CONDON",
            "state": "OR",
            "postal_code": "97823",
            "telephone_number": "541-384-2061",
            "fax_number": "541-384-3121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "422 NORTH MAIN ST.",
            "city": "CONDON",
            "state": "OR",
            "postal_code": "97823",
            "telephone_number": "541-384-2061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH GILLIAM COUNTY HEALTH DIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-26",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-30",
        "status": "A",
        "authorized_official_last_name": "HINTON",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "K.F.",
        "authorized_official_title_or_position": "BOARD CHAIRMAN",
        "authorized_official_telephone_number": "541-384-2061",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Gilliam Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Gilliam Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Condon, OR

Sources for this page

Verify at the official NPI Registry.