NPIMap

Organization Active NPI

Mid-Valley Healthcare, Inc.

Doing business as Samaritan Medical Group - Geriatric Medicine

  • Geriatric Medicine (Family Medicine) Physician
  • Lebanon, OR
National Provider Identifier
1043838519
Registry record updated Jul 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
Legal business name
MID-VALLEY HEALTHCARE, INC.
Doing business as
Samaritan Medical Group - Geriatric Medicine
Practice address
400 N Santiam Hwy
Lebanon, OR 97355
Phone
(541) 451-6413
Fax
(541) 812-2041
NPI assigned
Jul 10, 2020
Last updated
Jul 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2024

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

Authorized official

Name
Wendie Wunderwald
Title
Ceo
Phone
(541) 451-7195

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207QG0300X Primary

Addresses

Primary practice location

400 N Santiam Hwy
Lebanon, OR 97355

Mailing address

100 Mullins Dr Ste C2
Lebanon, OR 97355-2868
Phone (541) 451-6413

Other names 1

  • Samaritan Medical Group - Geriatric Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031111000297 OR Part B Supplier - Clinic/Group Practice 2769391523 Receives reassigned benefits from 458 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lebanon, OR; Sweet Home, OR; Newport, OR; Halsey, OR; Brownsville, OR

Other NPIs on the same Medicare enrollment 27

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 27

National Provider Directory

National Provider Directory
Tax ID family
Lebanon Community HSP12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1594339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722211200000",
    "number": "1043838519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MULLINS DR STE C2",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973552868",
            "telephone_number": "541-451-6413",
            "fax_number": "541-812-2041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N SANTIAM HWY",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "97355",
            "telephone_number": "541-451-6413",
            "fax_number": "541-812-2041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-VALLEY HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-10",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-19",
        "status": "A",
        "authorized_official_last_name": "WUNDERWALD",
        "authorized_official_first_name": "WENDIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-451-7195"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Samaritan Medical Group - Geriatric Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lebanon, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.