Active NPI
Diane M Krueger, MD
- Anesthesiology Physician
- Corvallis, OR
National Provider Identifier
1053332221
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- MD21183
- Practice address
- 3509 NW Samaritan Dr Ste 201
Corvallis, OR 97330-3893 - Phone
- (541) 768-4260
- NPI assigned
- Jul 22, 2006
- Last updated
- Jan 28, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | MD21183 | OR | Primary |
Addresses
Primary practice location
3509 NW Samaritan Dr Ste 201
Corvallis, OR 97330-3893
Mailing address
PO Box 84741
Ms 316006
Seattle, WA 98124
Phone (503) 372-2740
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 130074 | Medicaid | OR | |
| 8231854 | Medicaid | WA | |
| XPY199011 | Medicaid | CA | |
| 050065206 | Other | OR | RR MEDICARE |
| 805344700 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21183 | OR | MD | Massage Therapist |
Organizations & group practices 1
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.
-
- Anesthesiology Physician
- Corvallis, OR
- NPI 1629315536
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359331200000",
"number": "1053332221",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 84741",
"address_2": "MS 316006",
"city": "SEATTLE",
"state": "WA",
"postal_code": "98124",
"telephone_number": "503-372-2740",
"fax_number": "503-372-2754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3509 NW SAMARITAN DR STE 201",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973303893",
"telephone_number": "541-768-4260"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUEGER",
"first_name": "DIANE",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-22",
"last_updated": "2013-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "OR",
"license": "MD21183",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "130074",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8231854",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "XPY199011",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "050065206",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "805344700",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Corvallis, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.