NPIMap

Organization Active NPI

Mid-Columbia Medical Center

Doing business as Adventist Health Columbia Gorge

  • Urology Physician
  • The Dalles, OR
National Provider Identifier
1164735478
Registry record updated Apr 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
MID-COLUMBIA MEDICAL CENTER
Doing business as
Adventist Health Columbia Gorge
Gorge Urology
Practice address
1805 E 19TH St
The Dalles, OR 97058-0000
Phone
(541) 296-2201
Fax
(541) 296-1237
NPI assigned
Jul 16, 2010
Last updated
Apr 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2025

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

Authorized official

Name
Kyle King
Title
Service Area President
Phone
(503) 261-4405

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

1805 E 19TH St
The Dalles, OR 97058-0000

Mailing address

PO Box 1520
The Dalles, OR 97058-0000
Phone (541) 296-2201

Other identifiers 2

IdentifierTypeStateIssuer
500630716MedicaidOR
2008645MedicaidWA

Other names 2

  • Adventist Health Columbia Gorge Doing business as
  • Gorge Urology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031209000244 OR Part B Supplier - Clinic/Group Practice 3779487251 Receives reassigned benefits from 219 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hood River, OR; The Dalles, OR

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1279238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744588800000",
    "number": "1164735478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1520",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "970580000",
            "telephone_number": "541-296-2201",
            "fax_number": "541-296-1237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 E 19TH ST",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "970580000",
            "telephone_number": "541-296-2201",
            "fax_number": "541-296-1237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-COLUMBIA MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-16",
        "last_updated": "2025-04-14",
        "certification_date": "2025-04-14",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "SERVICE AREA PRESIDENT",
        "authorized_official_telephone_number": "503-261-4405"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500630716",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2008645",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adventist Health Columbia Gorge",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gorge Urology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gorge Urology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in The Dalles, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 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.