NPIMap

Individual provider Active NPI

Mark Warnholz Williams, MD

  • Family Medicine Physician
  • Redmond, OR
National Provider Identifier
1942564281
Registry record updated Apr 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD174000 Issued in OR
Practice address
211 NW Larch Ave
Redmond, OR 97756-1357
Phone
(541) 548-2164
Fax
(541) 548-0534
NPI assigned
Jul 2, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 6536 AK
Family Medicine Physician 207Q00000X MD174000 OR Primary

Addresses

Primary practice location

211 NW Larch Ave
Redmond, OR 97756-1357

Mailing address

PO Box 5579
Bend, OR 97708-5579
Phone (541) 548-2164

Other identifiers 1

IdentifierTypeStateIssuer
MD8531MedicaidAK

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mwilliams17918@secure.stcharleshealthcare.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151009000527 OR Practitioner - Family Practice 0840444295 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Nevada School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Charles Health System IncGroup PAC ID 8729111513, 379 clinicians

Practice addresses (Care Compare)

1245 NW 4TH St
101 Surg Speci
Redmond, OR 97756-1680
Phone (541) 548-7761

211 NW Larch Ave
Family Care
Redmond, OR 97756-1357
Phone (541) 548-2164

Hospital & facility affiliations

  • St. Charles Home Health Services Home health agency, Bend, OR, CCN 387026
  • Partners Home Health Home health agency, Bend, OR, CCN 387067
  • Home Health of Northwest, LLC Home health agency, Bend, OR, CCN 387316
  • Mission Home Health of Bend Home health agency, Bend, OR, CCN 387160
  • St Charles Medical Center - Bend Hospital, Bend, OR, CCN 380047
  • St Charles Medical Center Prineville Hospital, Prineville, OR, CCN 381313
  • St Charles Madras Hospital, Madras, OR, CCN 381324

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions11
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
St. Charles Health System, Inc. CurrentSince Oct 1, 2015 Accepting new patients
St. Charles Health System, Inc. Family Medicine CurrentSince Oct 1, 2015 Accepting new patients

Locations

29358 Network Pl
Chicago, IL 60673

2500 NE Neff Rd
Bend, OR 97701
Phone (541) 388-4333

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

Interoperability endpoints

  • Direct secure messaging: mwilliams17918@secure.stcharleshealthcare.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1341187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587600000000",
    "number": "1942564281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5579",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977085579",
            "telephone_number": "541-548-2164",
            "fax_number": "541-548-0534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 NW LARCH AVE",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977561357",
            "telephone_number": "541-548-2164",
            "fax_number": "541-548-0534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "MARK",
        "middle_name": "WARNHOLZ",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-02",
        "last_updated": "2020-04-23",
        "certification_date": "2020-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "6536",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD174000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD8531",
            "state": "AK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwilliams17918@secure.stcharleshealthcare.org",
            "affiliation": "N",
            "address_1": "211 NW Larch Ave",
            "city": "Redmond",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977561357",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Redmond, OR

Sources for this page

Verify at the official NPI Registry.