NPIMap

Organization Active NPI

Good Samaritan Hospital Corvallis

Doing business as Samaritan Urology - Corvallis

  • Urology Physician
  • Corvallis, OR
National Provider Identifier
1235409236
Registry record updated Jul 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
14-1074-1 Issued in OR
Legal business name
GOOD SAMARITAN HOSPITAL CORVALLIS
Doing business as
Samaritan Urology - Corvallis
Practice address
990 NW Circle Blvd Suite 102
Corvallis, OR 97330-1967
Phone
(541) 768-5486
Fax
(541) 768-5484
NPI assigned
Jan 6, 2012
Last updated
Jul 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 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
Ceo-Gsrmc
Phone
(541) 768-7914

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 14-1074-1 OR Primary

Addresses

Primary practice location

990 NW Circle Blvd Suite 102
Corvallis, OR 97330-1967

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
500651453MedicaidOR

Other names 1

  • Samaritan Urology - Corvallis Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030319000024 OR Part A Provider - Hospital 1557270725 20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Corvallis, OR
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235409236. Details of each certification follow.

Hospital certification: CCN 380014

Legal name
GOOD SAMARITAN HOSPITAL CORVALLIS
Doing business as
GOOD SAMARITAN REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jan 13, 2016
Beds
188
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Dec 8, 1948 in OR
Enrollment address
3600 NW Samaritan Dr
Corvallis, OR 97330-3737
Main/Primary Hospital Location
Hospital subgroups
General

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 20

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

View all 20

Care Compare: Hospital

Medicare Care Compare
Listed as
Good Samaritan Regional Medical CenterCCN 380014 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2003753Samaritan Urology-Corvallis990 NW Circle Blvd Ste 102, Corvallis, OR 97330Certificate of waiverMar 22, 2028

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

990 NW Circle Blvd
Ste 102
Corvallis, OR 97330
Phone (541) 768-5486

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Samaritan Health Services Inc. Organization, Corvallis, OR Corporation, Non-profit, Chain home office Operational/Managerial Control Dec 17, 1992 100%
Abbe E Montgomery Individual Corporate DirectorBoard Member Jan 1, 2021
Becky Pape Individual Corporate DirectorBoard Member Jan 1, 2025
Joseph Cahill Individual Corporate OfficerCeo Aug 1, 2024
W-2 Managing EmployeeCeo Aug 1, 2024
Nancy Seifert Individual Corporate OfficerChair Nov 2, 2010
Corporate DirectorBoard Member Nov 2, 2010
Kelly Gallagher Individual Corporate DirectorSecretary Apr 23, 2018
Lyle Hutchens Individual Corporate DirectorBoard Member Jan 1, 2016
Richard Cronk Individual Corporate OfficerTreasurer Jan 1, 1998
Corporate DirectorBoard Member Jan 1, 1998
Tim Hennessy Individual Corporate DirectorBoard Member Nov 2, 2011
Steve Uerlings Individual Corporate DirectorBoard Member Apr 23, 2013
Josiah S Johnson Individual Corporate OfficerCeo-Gsrmc Dec 2, 2024
W-2 Managing EmployeeCeo-Gsrmc Dec 2, 2024
Operational/Managerial ControlCeo-Gsrmc Dec 2, 2024
Eric Thompson Individual Corporate DirectorBoard Member Jan 1, 2001
Surinder M Vasdev Individual Corporate DirectorBoard Member Aug 20, 2024
David Marshall Individual Corporate DirectorBoard Member Aug 1, 2024

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 14

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 14

Affiliated clinicians 617

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 617

NPI Registry JSON

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

{
    "created_epoch": "1325808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722384000000",
    "number": "1235409236",
    "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": "990 NW CIRCLE BLVD SUITE 102",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973301967",
            "telephone_number": "541-768-5486",
            "fax_number": "541-768-5484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN HOSPITAL CORVALLIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-06",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A",
        "authorized_official_last_name": "CAHILL",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO-GSRMC",
        "authorized_official_telephone_number": "541-768-7914",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OR",
            "license": "14-1074-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500651453",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Samaritan Urology - Corvallis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Corvallis, OR

Sources for this page

Verify at the official NPI Registry.