Individual provider Active NPI

Christine Wung, PSYD

  • Clinical Psychologist
  • Salem, OR
National Provider Identifier
1043408024
Registry record updated Oct 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
1923 Issued in OR
Practice address
2485 12TH St SE
WVP Boulder Creek
Salem, OR 97302
Phone
(503) 967-1411
NPI assigned
Oct 4, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 1923 OR Primary

Addresses

Primary practice location

2485 12TH St SE
WVP Boulder Creek
Salem, OR 97302

Mailing address

PO Box 4025
Salem, OR 97302-1025
Phone (503) 269-6330

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090306000277 OR Practitioner - Clinical Psychologist 0840356473 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Peacehealth Medical GroupGroup PAC ID 9032023270, 256 clinicians

Practice addresses (Care Compare)

1200 Hilyard St
Eugene, OR 97401-8122
Phone (458) 205-6011

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1923ORMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Peacehealth Medical Group CurrentSince Aug 8, 2015 Accepting new patients
Peacehealth Medical Group CurrentSince Aug 8, 2015 Accepting new patients

Locations

4010 Aerial Way
Eugene, OR 97402
Phone (541) 242-8300

1200 Hilyard St
Eugene, OR 97401
Phone (458) 205-7070

1115 SE 164th Ave
Dept 358
Vancouver, WA 98683
Phone (360) 729-1253

Networks

  • WA PPO C-SNP
  • devoted network organization-83621310-88c0-4660-8f8d-b8ea8f4dc04e

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.

NPI Registry JSON

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

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412899200000",
    "number": "1043408024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4025",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973021025",
            "telephone_number": "503-269-6330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2485 12TH ST SE",
            "address_2": "WVP BOULDER CREEK",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97302",
            "telephone_number": "503-967-1411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WUNG",
        "first_name": "CHRISTINE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-04",
        "last_updated": "2014-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "1923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.