Active NPI
Carol A Severson, LDM,CPM
- Midwife
- Albany, OR
National Provider Identifier
1104957307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Midwife
- License
- DEM-LD102953
- Practice address
- 1209 Shortridge St SE
Albany, OR 97322-6934 - Phone
- (541) 928-1002
- Fax
- (541) 327-2721
- NPI assigned
- Mar 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Midwife | 176B00000X | DEM-LD102953 | OR | Primary |
Addresses
Primary practice location
1209 Shortridge St SE
Albany, OR 97322-6934
Mailing address
2532 Santiam Hwy SE
PMB 314
Albany, OR 97322-5211
Phone (541) 928-1002
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 140058 | Medicaid | OR | |
| 98040016 | Other | OR | NARM |
| LDM-LD 102953 | Other | OR | HEALTH LICENSING BOARD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DEM-LD102953 | OR | MD | Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1104957307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2532 SANTIAM HWY SE",
"address_2": "PMB 314",
"city": "ALBANY",
"state": "OR",
"postal_code": "973225211",
"telephone_number": "541-928-1002",
"fax_number": "541-327-2721"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1209 SHORTRIDGE ST SE",
"city": "ALBANY",
"state": "OR",
"postal_code": "973226934",
"telephone_number": "541-928-1002",
"fax_number": "541-327-2721"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEVERSON",
"first_name": "CAROL",
"middle_name": "A",
"credential": "LDM,CPM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-08",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "176B00000X",
"taxonomy_group": "",
"desc": "Midwife",
"state": "OR",
"license": "DEM-LD102953",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "140058",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NARM",
"identifier": "98040016",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH LICENSING BOARD",
"identifier": "LDM-LD 102953",
"state": "OR"
}
],
"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 Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.