NPIMap

Organization Active NPI

St. Charles Health System, Inc.

Doing business as St. Charles Behavioral Health

  • Clinical Social Worker
  • Bend, OR
National Provider Identifier
1780698696
Registry record updated May 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
ST. CHARLES HEALTH SYSTEM, INC.
Doing business as
St. Charles Behavioral Health
Practice address
2542 NE Courtney Dr
Bend, OR 97701-7685
Phone
(541) 706-2768
Fax
(541) 706-4760
NPI assigned
Jul 28, 2006
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
Chief Financial Officer
Phone
(541) 382-4321

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X OR
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X OR
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X OR
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X OR Primary

Addresses

Primary practice location

2542 NE Courtney Dr
Bend, OR 97701-7685

Mailing address

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

Other names 1

  • St. Charles Behavioral Health 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 OR

Enrollment records 1

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

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
Tax ID family
St Charles Health System19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Locations

2200 NE Neff Rd
Bend, OR 97701
Phone (541) 322-2395

360 SW Bond St
Ste 330
Bend, OR 97702
Phone (541) 706-2981

211 NW Larch Ave
Redmond, OR 97756
Phone (541) 548-2164

Practitioners & affiliated clinicians

Practitioners 161

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 161

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683244800000",
    "number": "1780698696",
    "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": "541-706-4760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2542 NE COURTNEY DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977017685",
            "telephone_number": "541-706-2768",
            "fax_number": "541-706-4760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CHARLES HEALTH SYSTEM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "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": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "541-382-4321"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Charles Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.