NPIMap

South Salem Rehabilitation, LLC

Organization Active NPI Skilled Nursing Facility · Salem, OR

NPI 1215071998 · NPPES record last updated Feb 19, 2025

Key facts

NPI
1215071998
Entity type
Organization (NPI type 2)
Primary specialty
Skilled Nursing Facility 314000000X
Legal business name
SOUTH SALEM REHABILITATION, LLC
Practice address
3445 Boone Rd SE
Salem, OR 97317-9336
Phone
(503) 576-3000
NPI assigned
Feb 16, 2007
Organization subpart
No

Authorized official

Name
Karl Miller Jr.
Title
Ceo
Phone
(503) 570-3405

Other NPIs on the same Medicare enrollment 10

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

Corporate family (same tax ID) 24

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

Practitioners 102

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

View all 102

Medicare participation

Medicare fee-for-service enrollment
Enrolled in OR

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040130000799 OR Part B Supplier - Clinic/Group Practice 5799688230 Receives reassigned benefits from 3,391 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portland, OR; Salem, OR; Tigard, OR; Tualatin, OR; Mount Angel, OR; Beaverton, OR; Clackamas, OR; Eugene, OR…

National Provider Directory

Tax ID family
Permananet Clinic (150 organizations share this tax ID)

Locations

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

10315 NE Tanasbourne Dr
Hillsboro, OR 97124
Phone (503) 531-1700

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Yes

Addresses

Primary practice location

3445 Boone Rd SE
Salem, OR 97317-9336

Mailing address

25117 SW Parkway Ave
Suite F
Wilsonville, OR 97070-9697

Other names

  • Salem Transitional Care Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinServi Other Ability Network

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 19, 2025.

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739923200000",
    "number": "1215071998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25117 SW PARKWAY AVE",
            "address_2": "SUITE F",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970709697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3445 BOONE RD SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973179336",
            "telephone_number": "503-576-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SALEM REHABILITATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "KARL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "503-570-3405",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinServi",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Salem Transitional Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salem, OR

All providers in Salem, OR · Skilled Nursing Facility in Oregon

Sources for this page

Verify at the official NPI Registry.