NPIMap

Organization Active NPI

Santiam Memorial Hospital

Doing business as Santiam Medical Clinic

  • Family Medicine Physician
  • Mill City, OR
National Provider Identifier
1205048097
Registry record updated Sep 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SANTIAM MEMORIAL HOSPITAL
Doing business as
Santiam Medical Clinic
Practice address
280 S First Ave
Mill City, OR 97360
Phone
(503) 897-4100
Fax
(503) 897-2673
NPI assigned
May 4, 2007
Last updated
Sep 28, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2016

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

Authorized official

Name
Shannon R Waddle
Title
Office Manager
Phone
(503) 897-4100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

280 S First Ave
Mill City, OR 97360

Mailing address

PO Box 47
Mill City, OR 97360-0047
Phone (503) 897-4100

Other names 1

  • Santiam Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040130000239 OR Part B Supplier - Clinic/Group Practice 6103729751 Receives reassigned benefits from 154 practitioners
22 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mill City, OR; Aumsville, OR; Sublimity, OR; Stayton, OR

Other NPIs on the same Medicare enrollment 22

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

View all 22

National Provider Directory

National Provider Directory

Locations

280 S 1st Ave
Mill City, OR 97360
Phone (503) 897-4100

1401 N 10th Ave
Ste 100
Stayton, OR 97383
Phone (503) 769-6386

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475020800000",
    "number": "1205048097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 47",
            "city": "MILL CITY",
            "state": "OR",
            "postal_code": "973600047",
            "telephone_number": "503-897-4100",
            "fax_number": "503-897-2673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 S FIRST AVE",
            "city": "MILL CITY",
            "state": "OR",
            "postal_code": "97360",
            "telephone_number": "503-897-4100",
            "fax_number": "503-897-2673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTIAM MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2016-09-28",
        "status": "A",
        "authorized_official_last_name": "WADDLE",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "503-897-4100"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Santiam Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mill City, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2016; 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.