NPIMap

Organization Active NPI

Good Samaritan Hospital Corvallis

Doing business as Samaritan Breast, Reconstruction & Surgical Oncology

  • Plastic Surgery Physician
  • Corvallis, OR
National Provider Identifier
1205192457
Registry record updated Oct 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
14-1074 Issued in OR
Legal business name
GOOD SAMARITAN HOSPITAL CORVALLIS
Doing business as
Samaritan Breast, Reconstruction & Surgical Oncology
Practice address
996 NW Circle Blvd
Suite 103
Corvallis, OR 97330-1485
Phone
(541) 768-1252
Fax
(541) 768-9355
NPI assigned
Apr 2, 2012
Last updated
Oct 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2024

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

Authorized official

Name
Joseph M. Cahill III
Title
Gsrmc - Ceo
Phone
(541) 768-5009

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 14-1074 OR Primary
Plastic and Reconstructive Surgery Physician 2086S0122X
Surgical Oncology Physician 2086X0206X

Addresses

Primary practice location

996 NW Circle Blvd
Suite 103
Corvallis, OR 97330-1485

Mailing address

PO Box 1189
Corvallis, OR 97339-1189
Phone (541) 768-6768

Other identifiers 1

IdentifierTypeStateIssuer
500651831MedicaidOR

Other names 1

  • Samaritan Breast, Reconstruction & Surgical Oncology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031125000163 OR Part B Supplier - Clinic/Group Practice 1557270725 Receives reassigned benefits from 589 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Corvallis, OR; Albany, OR

National Provider Directory

National Provider Directory
Tax ID family
Good Samaritan Hospital50 organizations share this tax ID, including this one

Other organizations with this tax ID 49

Organizations that report the same tax identification number in the National Provider Directory.

View all 49

Locations

996 NW Circle Blvd
Ste 103
Corvallis, OR 97330
Phone (541) 768-1252

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1333324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728259200000",
    "number": "1205192457",
    "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",
            "telephone_number": "541-768-6768",
            "fax_number": "541-768-9771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "996 NW CIRCLE BLVD",
            "address_2": "SUITE 103",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973301485",
            "telephone_number": "541-768-1252",
            "fax_number": "541-768-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN HOSPITAL CORVALLIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-02",
        "last_updated": "2024-10-07",
        "certification_date": "2024-10-07",
        "status": "A",
        "authorized_official_last_name": "CAHILL",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "GSRMC - CEO",
        "authorized_official_telephone_number": "541-768-5009",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "OR",
            "license": "14-1074",
            "primary": true
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500651831",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Samaritan Breast, Reconstruction & Surgical Oncology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 7, 2024; 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.