NPIMap

Individual provider Active NPI

Michelle Renae-Pippel Keller, PA-C

  • Surgical Physician Assistant
  • Corvallis, OR
National Provider Identifier
1154763050
Registry record updated Jan 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA173678 Issued in OR
Practice address
3615 NW Samaritan Dr
Suite 210
Corvallis, OR 97330-3783
Phone
(541) 768-4501
NPI assigned
Jul 22, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X
Surgical Physician Assistant 363AS0400X PA173678 OR Primary

Addresses

Primary practice location

3615 NW Samaritan Dr
Suite 210
Corvallis, OR 97330-3783

Mailing address

PO Box 1189
Corvallis, OR 97339-1189

Other identifiers 2

IdentifierTypeStateIssuer
206147OtherILMEDICARE PTAN (GROUP)
F400173350OtherILMEDICARE PTAN (INDIVIDUAL)

Other names 1

  • Michelle Renae-Pippel Johnston Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mkeller125175@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
I20150930000914 OR Practitioner - Physician Assistant 3577790500 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Icco LLCGroup PAC ID 1355406729, 133 clinicians
Good Samaritan Hospital CorvallisGroup PAC ID 1557270725, 372 clinicians

Practice addresses (Care Compare)

1755 SW Baker St
McMinnville, OR 97128-9112
Phone (971) 900-4522

186 W Ellendale Ave
Dallas, OR 97338-1408
Phone (541) 640-7625

3600 NW Samaritan Dr
Corvallis, OR 97330-3737

598 E 13TH Ave
Eugene, OR 97401-4783
Phone (541) 636-3473

Hospital & facility affiliations

  • Good Samaritan Regional Medical Center Hospital, Corvallis, OR, CCN 380014
  • Samaritan Albany General Hospital Hospital, Albany, OR, CCN 380022
  • Samaritan Lebanon Community Hospital Hospital, Lebanon, OR, CCN 381323
  • Samaritan North Lincoln Hospital Hospital, Lincoln City, OR, CCN 381302
  • Samaritan Pacific Community Hospital Hospital, Newport, OR, CCN 381314

Merit-based Incentive Payment System (MIPS)

Final score
91.14 of 100Reported as group
Quality
85.78
Promoting interoperability
100
Improvement activities
40
Cost
78.31

Merit-based Incentive Payment System (MIPS)

Final score
93.65 of 100Reported as group
Quality
86.8
Promoting interoperability
100
Improvement activities
40
Cost
86.36

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA173678ORMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Samaritan Pacific Health Services, Inc CurrentSince Jan 1, 2026 Accepting new patients
Mid-Valley Healthcare, Inc. CurrentSince Jan 24, 2026 Accepting new patients
Samaritan North Lincoln Hospital CurrentSince Jan 24, 2026 Accepting new patients
Samaritan Pacific Health Services, Inc. CurrentSince Jan 1, 2026 Accepting new patients
Samaritan North Lincoln Hospital CurrentSince Jan 1, 2026 Accepting new patients
Mid-Valley Healthcare Inc CurrentSince Jan 1, 2026 Accepting new patients
Icco, LLC CurrentSince Aug 15, 2022 Accepting new patients
Samaritan North Lincoln Hospital CurrentSince Jan 1, 2026 Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Aug 1, 2015 Accepting new patients
Mid-Valley Healthcare, Inc. CurrentSince Jan 1, 2026 Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Aug 1, 2015 Accepting new patients
Icco, LLC Past Accepting new patients
Geisinger Clinic Past Accepting new patients

Locations

3600 NW Samaritan Dr
Ste 227
Corvallis, OR 97330
Phone (541) 768-1261

3615 NW Samaritan Dr
Ste 210
Corvallis, OR 97330
Phone (541) 768-4501

3600 NW Samaritan Dr
Corvallis, OR 97330
Phone (541) 768-4906

598 E 13th Ave
Eugene, OR 97401
Phone (541) 636-3473

3400 Cooperative Way
Lebanon, OR 97355
Phone (541) 333-6605

Organizations & group practices 18

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.

View all 18

Hospital & facility affiliations 74

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

View all 74

NPI Registry JSON

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

{
    "created_epoch": "1374451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610582400000",
    "number": "1154763050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1189",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3615 NW SAMARITAN DR",
            "address_2": "SUITE 210",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303783",
            "telephone_number": "541-768-4501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "MICHELLE",
        "middle_name": "RENAE-PIPPEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-22",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OR",
            "license": "PA173678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN (GROUP)",
            "identifier": "206147",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN (INDIVIDUAL)",
            "identifier": "F400173350",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mkeller125175@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "3615 NW Samaritan Dr",
            "address_2": "Suite 210",
            "city": "Corvallis",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973303783",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "JOHNSTON",
            "middle_name": "RENAE-PIPPEL",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Corvallis, OR

Sources for this page

Verify at the official NPI Registry.