NPIMap

Individual provider Active NPI

Michael Craig Mallea, M.D.

  • Nephrology Physician
  • Springfield, OR
National Provider Identifier
1043235377
Registry record updated Jun 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
MD20251 Issued in OR
Practice address
3355 Riverbend Dr Ste 200
Springfield, OR 97477-8800
Phone
(541) 868-9247
Fax
(541) 485-0452
NPI assigned
Jul 13, 2006
Last updated
Jun 29, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X M7108 ID
Nephrology Physician 207RN0300X M7108 ID
Nephrology Physician 207RN0300X MD20251 OR Primary

Addresses

Primary practice location

3355 Riverbend Dr Ste 200
Springfield, OR 97477-8800

Mailing address

3355 Riverbend Dr
Ste 200
Springfield, OR 97477-8800
Phone (541) 868-9247

Other practice location 1

3525 E Louise Dr Ste 195
Meridian, ID 83642-6303
Phone (208) 846-8335

Other practice location 2

4424 E Flamingo Ave Ste 195
Nampa, ID 83687-9289
Phone (208) 846-8335

Other practice location 3

1109 W Myrtle St Ste 100
Boise, ID 83702-6971
Phone (208) 846-8335

Other practice location 4

4620 Enterprise Way Ste 101
Caldwell, ID 83605
Phone (208) 846-8335

Other identifiers 5

IdentifierTypeStateIssuer
12252OtherIDBLUE CROSS
150023MedicaidOR
390004362OtherIDRR MEDICARE
000010002160OtherIDBLUE SHIELD
003813700MedicaidID

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
I20100825000365 OR Practitioner - NephrologyPractitioner - Internal Medicine 6901713890 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
University of Utah School of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Eugene Springfield Nephrology Associates PCGroup PAC ID 7517951841, 14 clinicians

Practice addresses (Care Compare)

1077 Gateway Loop
Springfield, OR 97477-1114
Phone (541) 485-6478

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M7108IDMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Eugene Springfield Nephrology Associates, PC Nephrology CurrentSince Jun 2, 2022 Accepting new patients
Northwest Kidney Centers PastSince Jan 15, 2023 Accepting new patients
Northwest Kidney Centers Past Accepting new patients

Locations

1077 Gateway Loop
Springfield, OR 97477
Phone (541) 485-6478

3355 Riverbend Dr
Ste 200
Springfield, OR 97477
Phone (541) 485-6478

Networks

  • devoted network organization-83621310-88c0-4660-8f8d-b8ea8f4dc04e

Interoperability endpoints

  • Direct secure messaging: mmallea42417@direct.acumenmd.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 40

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

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656460800000",
    "number": "1043235377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3355 RIVERBEND DR",
            "address_2": "STE 200",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974778800",
            "telephone_number": "541-868-9247",
            "fax_number": "541-485-0452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3355 RIVERBEND DR STE 200",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974778800",
            "telephone_number": "541-868-9247",
            "fax_number": "541-485-0452"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3525 E Louise Dr Ste 195",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836426303",
            "country_code": "US",
            "telephone_number": "208-846-8335",
            "fax_number": "208-846-8336",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4424 E Flamingo Ave Ste 195",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836879289",
            "country_code": "US",
            "telephone_number": "208-846-8335",
            "fax_number": "208-846-8336",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1109 W Myrtle St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837026971",
            "country_code": "US",
            "telephone_number": "208-846-8335",
            "fax_number": "208-846-8336",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4620 Enterprise Way Ste 101",
            "address_purpose": "LOCATION",
            "city": "Caldwell",
            "state": "ID",
            "postal_code": "83605",
            "country_code": "US",
            "telephone_number": "208-846-8335",
            "fax_number": "208-846-8336",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLEA",
        "first_name": "MICHAEL",
        "middle_name": "CRAIG",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "ID",
            "license": "M7108",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "ID",
            "license": "M7108",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "OR",
            "license": "MD20251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "12252",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150023",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "390004362",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010002160",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003813700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, OR

Sources for this page

Verify at the official NPI Registry.