NPIMap

Individual provider Active NPI

Kenneth Thomas Goodell, KEN GOODELL

  • Emergency Medicine Physician
  • Cottage Grove, OR
National Provider Identifier
1225164379
Registry record updated Nov 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
DO150423 Issued in OR
Practice address
1515 Village Dr
Emergency Department
Cottage Grove, OR 97424-9700
Phone
(541) 942-0511
NPI assigned
Feb 25, 2007
Last updated
Nov 10, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X DO150423 OR Primary

Addresses

Primary practice location

1515 Village Dr
Emergency Department
Cottage Grove, OR 97424-9700

Mailing address

PO Box 1193
Corvallis, OR 97339-1193

Other practice location 1

525 N Santiam Hwy
Lebanon, OR 97355-4363
Phone (541) 258-2101

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kgoodell155236@samhealth.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100427000316 OR Practitioner - Emergency Medicine 7810024650 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of New England, College of Osteo Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mid-Valley Healthcare IncGroup PAC ID 2769391523, 143 clinicians

Practice addresses (Care Compare)

525 N Santiam Hwy
Lebanon, OR 97355-4363
Phone (541) 258-2101

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.77 of 100Reported as group
Quality
88.09
Promoting interoperability
100
Improvement activities
40
Cost
84.48

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-Valley Healthcare, Inc. CurrentSince Sep 1, 2018 Accepting new patients
Mid-Valley Healthcare Inc Current Accepting new patients
Mid-Valley Healthcare Inc CurrentSince Sep 1, 2018 Accepting new patients
Peacehealth Medical Group Cottage Grove Current Accepting new patients
Peacehealth CurrentSince Oct 9, 2012 Accepting new patients

Locations

777 NW 9th St
Ste 102
Corvallis, OR 97330
Phone (541) 768-6769

1515 Village Dr
Cottage Grove, OR 97424
Phone (541) 767-5200

325 Park St
Lebanon, OR 97355
Phone (541) 451-7200

525 N Santiam Hwy
Lebanon, OR 97355
Phone (541) 258-2101

Interoperability endpoints

  • Direct secure messaging: kgoodell155236@samhealth.direct-ci.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1172361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604966400000",
    "number": "1225164379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1193",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 VILLAGE DR",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "COTTAGE GROVE",
            "state": "OR",
            "postal_code": "974249700",
            "telephone_number": "541-942-0511"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "525 N Santiam Hwy",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "OR",
            "postal_code": "973554363",
            "country_code": "US",
            "telephone_number": "541-258-2101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOODELL",
        "first_name": "KENNETH",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "KEN GOODELL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-25",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "DO150423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kgoodell155236@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "525 N Santiam Hwy",
            "city": "Lebanon",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973554363",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cottage Grove, OR

Sources for this page

Verify at the official NPI Registry.