NPIMap

Organization Active NPI

Mary'S Peak Emergency Physicians

  • Emergency Medicine Physician
  • Corvallis, OR
National Provider Identifier
1194733360
Registry record updated Nov 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
MARY'S PEAK EMERGENCY PHYSICIANS
Practice address
3600 NW Samaritan Dr
Corvallis, OR 97330-3737
Phone
(541) 768-5021
NPI assigned
Aug 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2017

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

Authorized official

Name
Peter D. Gowing, DONPI 1821069899
Title
President
Phone
(541) 768-5021

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X OR Primary

Addresses

Primary practice location

3600 NW Samaritan Dr
Corvallis, OR 97330-3737

Mailing address

PO Box 96353
Oklahoma City, OK 73143-6353
Phone (800) 962-3303

Other identifiers 1

IdentifierTypeStateIssuer
078548MedicaidOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040322000521 OR Part B Supplier - Clinic/Group Practice 4688565559 Receives reassigned benefits from 24 practitioners
Practice locations: Corvallis, OR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510704000000",
    "number": "1194733360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 96353",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731436353",
            "telephone_number": "800-962-3303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 NW SAMARITAN DR",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303737",
            "telephone_number": "541-768-5021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY'S PEAK EMERGENCY PHYSICIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2017-11-15",
        "status": "A",
        "authorized_official_last_name": "GOWING",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-768-5021",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "078548",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Corvallis, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2017; 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.