Water's Edge Medical Clinic – Rural Health Clinic/Center, NPI 1407887052

Water's Edge Medical Clinic is a healthcare provider. based in The dalles, Oregon. specializing in Rural Health Clinic/Center. The NPI Number for Water's Edge Medical Clinic is 1407887052

Main info

Organization
Name
Water's Edge Medical Clinic
NPI
1407887052
Phone
(541) 506-6920
Address
551 LONE PINE BLVD
Authorized Official
KYLE KING SERVICE AREA PRESIDENT
Enumeration Date
5 July 2006
Last Update Date
14 April 2025
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience63
Completeness80
Years active:19State licenses:0Digital endpointsUpdated within 12 months

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Provider Addresses for Water's Edge Medical Clinic

  • Water's Edge, 551, Lone Pine Boulevard, The Dalles, Wasco County, Oregon, 97058, United States

    PO BOX 1520

    THE DALLES, OR 97058

    Phone: (541) 506-6920

    Fax: (541) 296-5451

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2003-11-25

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
O20031125000891ORural Health ClinicORTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 97058)

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Reviews

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Frequently asked questions

What is the standard ID for Water's Edge Medical Clinic in the U.S.?
In the U.S., Water's Edge Medical Clinic is identified by NPI 1407887052.
Is Water's Edge Medical Clinic currently accepting referrals based on NPI status?
Registry metadata lists Water's Edge Medical Clinic as active.
How should patients interpret Water's Edge Medical Clinic's specialty?
The extract shows Rural Health Clinic/Center for Water's Edge Medical Clinic. Clinical services aligned with this taxonomy classification.
What geographic area is tied to Water's Edge Medical Clinic?
Water's Edge Medical Clinic is associated with The Dalles, Oregon in the same public data insurers reference.
Who maintains Water's Edge Medical Clinic's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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