NPIMap

Individual provider Active NPI

Mary Kathleen Lane, PA-C

  • Medical Physician Assistant
  • Lebanon, OR
National Provider Identifier
1083738595
Registry record updated Nov 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA01341 Issued in OR
Practice address
325 Park St
Lebanon, OR 97355-4229
Phone
(541) 451-7200
Fax
(541) 451-7207
NPI assigned
Mar 19, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA01341 OR Primary
Medical Physician Assistant 363AM0700X 085-000746 IL

Addresses

Primary practice location

325 Park St
Lebanon, OR 97355-4229

Mailing address

PO Box 1193
Corvallis, OR 97339-1193

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address klane7060@samhealth.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090317000128 OR Practitioner - Physician Assistant 3274600044 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mid-Valley Healthcare IncGroup PAC ID 2769391523, 143 clinicians

Practice addresses (Care Compare)

325 Park St
Lebanon, OR 97355-4229
Phone (541) 451-7200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.77 of 100Reported as group
Quality
88.09
Promoting interoperability
100
Improvement activities
40
Cost
84.48

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085-000746ILMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-Valley Healthcare, Inc. CurrentSince Sep 21, 2013 Accepting new patients
Mid-Valley Healthcare Inc CurrentSince Sep 21, 2013 Accepting new patients
Firstcare Medical Foundation Past Accepting new patients

Locations

425 N Santiam Hwy
Lebanon, OR 97355
Phone (541) 451-6960

325 Park St
Lebanon, OR 97355
Phone (541) 451-7200

Organizations & group practices 4

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.

Hospital & facility affiliations 54

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 54

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604534400000",
    "number": "1083738595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1193",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 PARK ST",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973554229",
            "telephone_number": "541-451-7200",
            "fax_number": "541-451-7207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANE",
        "first_name": "MARY",
        "middle_name": "KATHLEEN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-19",
        "last_updated": "2020-11-05",
        "certification_date": "2020-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA01341",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085-000746",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "klane7060@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "325 Park St",
            "city": "Lebanon",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973554229",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lebanon, OR

Sources for this page

Verify at the official NPI Registry.