NPIMap

Individual provider Active NPI

Shane Matthew Gjesdal, MD

  • Obstetrics & Gynecology Physician
  • Albany, OR
National Provider Identifier
1164424586
Registry record updated Nov 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
MD29109 Issued in OR
Practice address
705 Elm St SW
Suite 200
Albany, OR 97321-1956
Phone
(541) 812-4850
Fax
(541) 812-4889
NPI assigned
Aug 15, 2005
Last updated
Nov 3, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X MD29109 OR Primary

Addresses

Primary practice location

705 Elm St SW
Suite 200
Albany, OR 97321-1956

Mailing address

PO Box 1188
Corvallis, OR 97339-1188
Phone (541) 812-4850

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sgjesdal7096@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
I20090811000042 OR Practitioner - Obstetrics/Gynecology 6103970132 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Kansas School of Med (KC/Wich/Sal), 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Albany General HospitalGroup PAC ID 9931097987, 191 clinicians

Practice addresses (Care Compare)

1046 6TH Ave SW
Albany, OR 97321-1916
Phone (541) 812-4000

705 Elm St SW
Suite 200
Albany, OR 97321-1957
Phone (541) 812-4850

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.37 of 100Reported as group
Quality
92.31
Promoting interoperability
100
Improvement activities
40
Cost
80.9

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Albany General Hospital Current Accepting new patients
Albany General Hospital CurrentSince Apr 23, 2012 Accepting new patients
Good Samaritan Hospital Corvallis Past Accepting new patients
Firstcare Medical Foundation Obstetrics & Gynecology PastSince Sep 1, 2004 Accepting new patients

Locations

815 NW 9th St
Ste 215
Corvallis, OR 97330
Phone (541) 768-1888

Interoperability endpoints

  • Direct secure messaging: sgjesdal7096@samhealth.direct-ci.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 38

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

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604361600000",
    "number": "1164424586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1188",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391188",
            "telephone_number": "541-812-4850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 ELM ST SW",
            "address_2": "SUITE 200",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973211956",
            "telephone_number": "541-812-4850",
            "fax_number": "541-812-4889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GJESDAL",
        "first_name": "SHANE",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-15",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OR",
            "license": "MD29109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sgjesdal7096@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "705 Elm St SW",
            "address_2": "Suite 200",
            "city": "Albany",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973211956",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Albany, OR

Sources for this page

Verify at the official NPI Registry.