NPIMap

Organization Active NPI

Winding Waters Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Enterprise, OR
National Provider Identifier
1922475219
Registry record updated Sep 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WINDING WATERS MEDICAL CLINIC
Practice address
603 Medical Pkwy
Enterprise, OR 97828-5124
Phone
(541) 426-4502
Fax
(541) 426-6403
NPI assigned
Aug 21, 2015
Last updated
Sep 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2023

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

Authorized official

Name
Keli Jean Dennis
Title
Coo
Phone
(541) 426-4502

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

603 Medical Pkwy
Enterprise, OR 97828-5124

Mailing address

603 Medical Pkwy
Enterprise, OR 97828-5124
Phone (541) 426-4502

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20151002000978 OR Part A Provider - Federally Qualified Health Center (FQHC) 8224346713 Practice locations: Enterprise, OR
O20160113000362 OR Part B Supplier - Clinic/Group Practice 8224346713 Receives reassigned benefits from 24 practitioners
1 other NPI on this enrollment
Practice locations: Enterprise, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922475219. Details of each certification follow.

Federally qualified health center certification: CCN 381964

Legal name
WINDING WATERS MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 28, 2015
Last certification
Sep 28, 2015
Ownership / control type
Non-profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 23, 2013 in OR
Enrollment address
603 Medical Pkwy
Enterprise, OR 97828-5124

Other NPIs with the same Medicare PAC ID 3

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

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Nicolas Powers Individual Corporate OfficerChief Financial Officer Aug 1, 2015
Kathy Capps Individual Corporate DirectorBoard Member Aug 20, 2014
William Finney Individual Corporate DirectorBoard Member Aug 20, 2014
Elizabeth C Powers Individual Corporate OfficerChief Executive Officer Aug 1, 2015
David Schmidt Individual Corporate DirectorBoard Member Aug 20, 2014
Keli Dennis Individual W-2 Managing Employee Aug 1, 2015
Nils Christoffersen Individual Corporate DirectorBoard Member Aug 20, 2014
David Harman Individual Corporate OfficerChair Aug 20, 2014
Rhonda Harguess Individual Corporate DirectorBoard Member Aug 20, 2014
Angie Lunde Individual Corporate DirectorBoard Member Aug 20, 2014
Maria Weer Individual Corporate OfficerSecretary Aug 20, 2014
Russell Peterson Individual Corporate OfficerVice-Chair Aug 20, 2014
Winding Waters Medical Clinic Organization, Enterprise, OR Non-profit 5% Or Greater Direct Ownership Interest Jul 23, 2013 100%
Cammie Hale Individual Corporate OfficerTreasurer Aug 20, 2014
Richard Bombaci Individual Corporate DirectorBoard Member Feb 5, 2015

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Winding Waters WallowaWallowa, OR, CCN 381004 Federally qualified health center Operational/Managerial Control (100%) Apr 8, 2022
Winding Waters Hearts for HealthEnterprise, OR, CCN 381006 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2022
Jan 1, 2022

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1440115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694476800000",
    "number": "1922475219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 MEDICAL PKWY",
            "city": "ENTERPRISE",
            "state": "OR",
            "postal_code": "978285124",
            "telephone_number": "541-426-4502",
            "fax_number": "541-426-6403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 MEDICAL PKWY",
            "city": "ENTERPRISE",
            "state": "OR",
            "postal_code": "978285124",
            "telephone_number": "541-426-4502",
            "fax_number": "541-426-6403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINDING WATERS MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-21",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A",
        "authorized_official_last_name": "DENNIS",
        "authorized_official_first_name": "KELI",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "541-426-4502"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Enterprise, OR

Sources for this page

Verify at the official NPI Registry.