NPIMap

Organization Active NPI

Mid-Columbia Medical Center

Doing business as Adventist Health Columbia Gorge

  • General Practice Physician
  • The Dalles, OR
National Provider Identifier
1053409599
Registry record updated Mar 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
MID-COLUMBIA MEDICAL CENTER
Doing business as
Adventist Health Columbia Gorge
Practice address
1700 E 19TH St
The Dalles, OR 97058-3317
Phone
(541) 296-1111
Fax
(541) 296-7619
NPI assigned
Oct 10, 2006
Last updated
Mar 28, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2025

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

Authorized official

Name
Kyle King
Title
Service Area President
Phone
(503) 261-4405

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X OR Primary

Addresses

Primary practice location

1700 E 19TH St
The Dalles, OR 97058-3317

Mailing address

1700 E 19TH St
The Dalles, OR 97058-3317
Phone (541) 296-7668

Other identifiers 2

IdentifierTypeStateIssuer
2008493MedicaidWA
070115MedicaidOR

Other names 1

  • ADVENTIST HEALTH COLUMBIA GORGE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031209000244 OR Part B Supplier - Clinic/Group Practice 3779487251 Receives reassigned benefits from 219 practitioners
16 other NPIs on this enrollment
Practice locations: Hood River, OR; The Dalles, OR

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

Locations (25 of 27)

319 E Jefferson St
Unit 220
Culver, IN 46511
Phone (315) 786-5059

2690 May St
Hood River, OR 97031
Phone (541) 386-2441

611 N Main St
Newberg, OR 97132

1713 E 19TH St
The Dalles, OR 97058

1715 E 19TH St
The Dalles, OR 97058

1717 E 19TH St
The Dalles, OR 97058

1719 E 19th St
The Dalles, OR 97058

1721 E 19TH St
The Dalles, OR 97058

1723 E 19TH St
The Dalles, OR 97058

1725 E 19TH St
The Dalles, OR 97058

1727 E 19TH St
The Dalles, OR 97058

1729 E 19TH St
The Dalles, OR 97058

1731 E 19TH St
The Dalles, OR 97058

1735 E 19TH St
The Dalles, OR 97058

1737 E 19TH St
The Dalles, OR 97058

1739 E 19TH St
The Dalles, OR 97058

1745 E 19TH St
The Dalles, OR 97058

1751 E 19TH St
The Dalles, OR 97058

1755 E 19TH St
The Dalles, OR 97058

1757 E 19TH St
The Dalles, OR 97058

1759 E 19TH St
The Dalles, OR 97058

1761 E 19TH St
The Dalles, OR 97058

1805 E 19th St
The Dalles, OR 97058
Phone (541) 296-2201

1810 E 19th St
Ste 211
The Dalles, OR 97058
Phone (503) 292-1400

425 E 7th St
The Dalles, OR 97058
Phone (541) 296-4610

Practitioners & affiliated clinicians

Practitioners 252

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 252

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743120000000",
    "number": "1053409599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 E 19TH ST",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "970583317",
            "telephone_number": "541-296-7668",
            "fax_number": "541-296-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 E 19TH ST",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "970583317",
            "telephone_number": "541-296-1111",
            "fax_number": "541-296-7619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-COLUMBIA MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2025-03-28",
        "certification_date": "2025-03-28",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "SERVICE AREA PRESIDENT",
        "authorized_official_telephone_number": "503-261-4405"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2008493",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "070115",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ADVENTIST HEALTH COLUMBIA GORGE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in The Dalles, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2025; 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.