NPIMap

Organization Active NPI

St. Charles Health System, Inc.

Doing business as St. Charles Prineville

  • Medicare Defined Swing Bed Hospital Unit
  • Prineville, OR
National Provider Identifier
1902089634
Registry record updated May 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
14-1466 Issued in OR
Legal business name
ST. CHARLES HEALTH SYSTEM, INC.
Doing business as
St. Charles Prineville
Practice address
384 SE Combs Flat Rd
Prineville, OR 97754-2562
Phone
(541) 447-6254
NPI assigned
Dec 17, 2007
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
Medicare Defined Swing Bed Hospital Unit 275N00000X 14-1466 OR Primary

Addresses

Primary practice location

384 SE Combs Flat Rd
Prineville, OR 97754-2562

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
218720MedicaidOR

Other names 1

  • St. Charles 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 OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080206000241 OR Part A Provider - Critical Access Hospital 3870402852 1 other NPI on this enrollment
Practice locations: Prineville, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902089634. Details of each certification follow.

Hospital certification: CCN 38Z313

Legal name
ST CHARLES HEALTH SYSTEM INC
Doing business as
ST. CHARLES PRINEVILLE
Organization structure
CorporationNon-profit
Incorporated
Dec 8, 1971 in OR
Enrollment address
384 SE Combs Flat Rd
Prineville, OR 97754-2562
Hospital Swing-Bed Unit

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 1

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

National Provider Directory

National Provider Directory
Tax ID family
St Charles Medical Cent19 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

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 DirectorBoard Member Jan 1, 2022
Steven G Gordon Individual Corporate DirectorBoard Member Sep 1, 2014
W-2 Managing Employee Jul 20, 2022
Matthew Swafford Individual Corporate Director Aug 1, 2021
Jenny Obrien Individual Corporate DirectorBoard Member Jan 1, 2022
James Orlikoff Individual Corporate DirectorBoard Member Jan 1, 2018
Ann Rhoads Individual Corporate DirectorBoard Member Jan 1, 2022
Daniel Schuette Individual Corporate DirectorBoard Member Dec 4, 2007
Jennifer Schmid Individual Corporate DirectorBoard Member Aug 1, 2019
John M Terhes Individual Corporate DirectorBoard Member Aug 1, 2019
Jarvis Sam Individual Corporate DirectorBoard Member Jan 1, 2022

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 9

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
St. Charles Family Care-PrinevillePrineville, OR, CCN 388505 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2010

Owned or controlled facilities with NPI records 13

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

View all 13

Practitioners & affiliated clinicians

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1197849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683244800000",
    "number": "1902089634",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "384 SE COMBS FLAT RD",
            "city": "PRINEVILLE",
            "state": "OR",
            "postal_code": "977542562",
            "telephone_number": "541-447-6254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CHARLES HEALTH SYSTEM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-17",
        "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": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "OR",
            "license": "14-1466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "218720",
            "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 Prineville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Charles Prineville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prineville, OR

Sources for this page

Verify at the official NPI Registry.