NPIMap

Organization Active NPI

Silverton Health

Doing business as Legacy Medical Group Orthopedics and Sports Medicine Silverton

  • Specialist
  • Silverton, OR
National Provider Identifier
1093828006
Registry record updated Jul 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
200550137NP Issued in OR
Legal business name
SILVERTON HEALTH
Doing business as
Legacy Medical Group Orthopedics and Sports Medicine Silverton
Practice address
452 Welch St
Silverton, OR 97381
Phone
(503) 873-1722
Fax
(503) 874-2470
NPI assigned
Aug 16, 2006
Last updated
Jul 20, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2018

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

Authorized official

Name
Sarah Jensen
Title
Interim Cfo
Phone
(503) 415-5145

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X MD25349 OR
Specialist 174400000X MD16538 OR
Specialist 174400000X MD24813 OR
Specialist 174400000X MD25866 OR
Specialist 174400000X 200550137NP OR Primary

Addresses

Primary practice location

452 Welch St
Silverton, OR 97381

Mailing address

PO Box 3417
Portland, OR 97208-3417
Phone (503) 873-1500

Other names 1

  • Legacy Medical Group Orthopedics and Sports Medicine Silverton Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040129000172 OR Part B Supplier - Clinic/Group Practice 8921901877 Receives reassigned benefits from 620 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Silverton, OR; Woodburn, OR; Salem, OR; Mount Angel, OR; Molalla, OR; Keizer, OR

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 91

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 91

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532044800000",
    "number": "1093828006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3417",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083417",
            "telephone_number": "503-873-1500",
            "fax_number": "503-873-1534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "452 WELCH ST",
            "city": "SILVERTON",
            "state": "OR",
            "postal_code": "97381",
            "telephone_number": "503-873-1722",
            "fax_number": "503-874-2470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SILVERTON HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2018-07-20",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "INTERIM CFO",
        "authorized_official_telephone_number": "503-415-5145"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OR",
            "license": "MD25349",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OR",
            "license": "MD16538",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OR",
            "license": "MD24813",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OR",
            "license": "MD25866",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OR",
            "license": "200550137NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy Medical Group Orthopedics and Sports Medicine Silverton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Silverton, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2018; 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.