NPIMap

Organization Active NPI

Good Samaritan Hospital Corvallis

Doing business as Samaritan Occupational Medicine-Albany

  • Internal Medicine Physician
  • Albany, OR
National Provider Identifier
1063779205
Registry record updated Nov 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
GOOD SAMARITAN HOSPITAL CORVALLIS
Doing business as
Samaritan Occupational Medicine-Albany
Practice address
1100 7TH Ave SW
Albany, OR 97321-1925
Phone
(541) 812-5600
NPI assigned
Apr 12, 2012
Last updated
Nov 8, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2018

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

Authorized official

Name
Becky Pape
Title
Ceo
Phone
(541) 768-5009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1100 7TH Ave SW
Albany, OR 97321-1925

Mailing address

1100 7TH Ave SW
Albany, OR 97321-1925
Phone (541) 812-5600

Other identifiers 1

IdentifierTypeStateIssuer
500651542MedicaidOR

Other names 1

  • Samaritan Occupational Medicine-Albany Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031125000163 OR Part B Supplier - Clinic/Group Practice 1557270725 Receives reassigned benefits from 589 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Corvallis, OR; Albany, OR

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D0711913Samaritan Occupational Medicine-Albany1100 SW 7TH Avenue, Albany, OR 97321Certificate of waiverAug 5, 2027

National Provider Directory

National Provider Directory
Tax ID family
Good Samaritan Hospital50 organizations share this tax ID, including this one

Other organizations with this tax ID 49

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

View all 49

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1334188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541635200000",
    "number": "1063779205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 7TH AVE SW",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973211925",
            "telephone_number": "541-812-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 7TH AVE SW",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973211925",
            "telephone_number": "541-812-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN HOSPITAL CORVALLIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-12",
        "last_updated": "2018-11-08",
        "status": "A",
        "authorized_official_last_name": "PAPE",
        "authorized_official_first_name": "BECKY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-768-5009"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500651542",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Samaritan Occupational Medicine-Albany",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Samaritan Occupational Medicine-Albany",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Albany, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.