Individual provider Active NPI

Kristi Lorraine Skoog, PA-C

  • Family Medicine Physician
  • Eugene, OR
National Provider Identifier
1164535118
Registry record updated Jan 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
00568 Issued in OR
Practice address
2710 Willamette St
Eugene, OR 97405-3238
Phone
(541) 640-7625
NPI assigned
Aug 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 00568 OR Primary

Addresses

Primary practice location

2710 Willamette St
Eugene, OR 97405-3238

Mailing address

1292 High St Ste 224
Eugene, OR 97401-3238
Phone (541) 500-2500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101222000265 OR Practitioner - Physician Assistant 7618165309 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Oregon Health Sciences University School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Icco LLCGroup PAC ID 1355406729, 133 clinicians

Practice addresses (Care Compare)

1445 Gateway Blvd
Cottage Grove, OR 97424-1224
Phone (541) 942-7000

1740 NW Goetz St
Roseburg, OR 97471-1613
Phone (541) 672-4885

2710 Willamette St
Eugene, OR 97405-3238
Phone (541) 735-3161

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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
00568ORMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Icco, LLC Family Medicine CurrentSince Aug 1, 2012 Accepting new patients
Firstcare Medical Foundation Family Medicine PastSince Sep 1, 2004 Accepting new patients
Good Samaritan Hospital Corvallis Past Accepting new patients
Icco, LLC Past Accepting new patients

Locations

1800 Coburg Rd
Eugene, OR 97401
Phone (541) 342-1632

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

5781 Main St
Springfield, OR 97478
Phone (541) 284-1694

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579824000000",
    "number": "1164535118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1292 HIGH ST STE 224",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974013238",
            "telephone_number": "541-500-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2710 WILLAMETTE ST",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974053238",
            "telephone_number": "541-640-7625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKOOG",
        "first_name": "KRISTI",
        "middle_name": "LORRAINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-16",
        "last_updated": "2020-01-24",
        "certification_date": "2020-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "00568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eugene, OR

Sources for this page

Verify at the official NPI Registry.