NPIMap

Individual provider Active NPI

Victoria Ann Shultz, PA-C

  • Physician Assistant
  • Springfield, OR
National Provider Identifier
1023351418
Registry record updated Sep 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA169767 Issued in OR
Practice address
2400 Hartman LN Ste 200
Springfield, OR 97477-1122
Phone
(541) 334-3350
Fax
(541) 343-3459
NPI assigned
Apr 3, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA169767 OR Primary

Addresses

Primary practice location

2400 Hartman LN Ste 200
Springfield, OR 97477-1122

Mailing address

2400 Hartman LN Ste 200
Springfield, OR 97477-1122
Phone (541) 334-3350

Other identifiers 1

IdentifierTypeStateIssuer
500677698MedicaidOR

Other names 1

  • Victoria Ann Penna / Waltz Former name

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
I20151229000582 OR Practitioner - Physician Assistant 1557581865 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Oregon Urology Institute PCGroup PAC ID 6608766399, 33 clinicians

Practice addresses (Care Compare)

2400 Hartman LN
Springfield, OR 97477-1118
Phone (541) 334-3350

2400 Hartman LN
Suite 200
Springfield, OR 97477-1122

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.78 of 100Reported as apm
Quality
80.38
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
86.57 of 100Reported as group
Quality
93.49
Promoting interoperability
100
Improvement activities
40
Cost
61.74

Merit-based Incentive Payment System (MIPS)

Final score
82.68 of 100Reported as group
Quality
73.02
Promoting interoperability
80
Improvement activities
40
Cost
85.92

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA169767ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Icco, LLC CurrentSince Aug 7, 2016 Accepting new patients

Locations

598 E 13th Ave
Eugene, OR 97401
Phone (541) 636-3473

87983 Territorial Rd
Veneta, OR 97487
Phone (541) 935-2200

Interoperability endpoints

  • Direct secure messaging: vwaltz@yourcarecommunity.org

Organizations & group practices 3

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 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1364947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695254400000",
    "number": "1023351418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 HARTMAN LN STE 200",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974771122",
            "telephone_number": "541-334-3350",
            "fax_number": "541-343-3459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 HARTMAN LN STE 200",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974771122",
            "telephone_number": "541-334-3350",
            "fax_number": "541-343-3459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHULTZ",
        "first_name": "VICTORIA",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-03",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA169767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500677698",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VICTORIA",
            "last_name": "PENNA / WALTZ",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Springfield, OR

Sources for this page

Verify at the official NPI Registry.