Active NPI
J Noonan, MD
- Orthopaedic Surgery of the Spine Physician
- Corvallis, OR
National Provider Identifier
1194759670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery of the Spine Physician
- License
- MD25797
- Practice address
- 3615 NW Samaritan Dr Ste 210
Corvallis, OR 97330-3771 - Phone
- (541) 768-4501
- NPI assigned
- Jul 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery of the Spine Physician | 207XS0117X | MD25797 | OR | Primary |
Addresses
Primary practice location
3615 NW Samaritan Dr Ste 210
Corvallis, OR 97330-3771
Mailing address
PO Box 1189
Corvallis, OR 97339-1189
Other practice location 1
74B Centennial Loop
Suite 100
Eugene, OR 97401-7918
Phone (541) 393-0100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 027887 | Medicaid | OR |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jnoonan124563@samhealth.direct-ci.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD25797 | OR | MD | Orthopaedic Surgery of the Spine Physician |
Interoperability endpoints
- jnoonan124563@samhealth.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611619200000",
"number": "1194759670",
"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 STE 210",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973303771",
"telephone_number": "541-768-4501"
}
],
"practiceLocations": [
{
"address_1": "74B Centennial Loop",
"address_2": "Suite 100",
"address_purpose": "LOCATION",
"city": "Eugene",
"state": "OR",
"postal_code": "974017918",
"country_code": "US",
"telephone_number": "541-393-0100",
"fax_number": "541-393-0104",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NOONAN",
"first_name": "J",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-10",
"last_updated": "2021-01-26",
"certification_date": "2021-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "207XS0117X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
"state": "OR",
"license": "MD25797",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "027887",
"state": "OR"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jnoonan124563@samhealth.direct-ci.com",
"affiliation": "N",
"address_1": "3615 NW Samaritan Dr Ste 210",
"city": "Corvallis",
"state": "OR",
"country_code": "US",
"postal_code": "973303771",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Jan 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.