NPIMap

Organization Active NPI

Three Oaks Anesthesia LLC

  • Anesthesiology Physician
  • Albany, OR
National Provider Identifier
1104586726
Registry record updated Mar 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
THREE OAKS ANESTHESIA LLC
Practice address
633 Waverly Dr SE
Albany, OR 97322-5078
Phone
(541) 286-2309
NPI assigned
Dec 22, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2025

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

Authorized official

Name
Dr. Jared Dale Grose, MDNPI 1497913834
Title
Authorized Official
Phone
(541) 232-3491

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

633 Waverly Dr SE
Albany, OR 97322-5078

Mailing address

PO Box 28
Corvallis, OR 97339-0028
Phone (541) 704-7999

Other practice location 1

1128 NE 2nd St
Corvallis, OR 97330-6230
Phone (541) 286-2309

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220322002889 OR Part B Supplier - Clinic/Group Practice 0648665067 Receives reassigned benefits from 6 practitioners
Practice locations: Albany, OR; Corvallis, OR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1640131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741564800000",
    "number": "1104586726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 28",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973390028",
            "telephone_number": "541-704-7999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 WAVERLY DR SE",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973225078",
            "telephone_number": "541-286-2309"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1128 NE 2nd St",
            "address_purpose": "LOCATION",
            "city": "Corvallis",
            "state": "OR",
            "postal_code": "973306230",
            "country_code": "US",
            "telephone_number": "541-286-2309",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THREE OAKS ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-22",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A",
        "authorized_official_last_name": "GROSE",
        "authorized_official_first_name": "JARED",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "541-232-3491",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Mar 10, 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.