NPIMap

Individual provider Active NPI

Jesse Kipperman

  • Psychiatry Physician
  • Corvallis, OR
National Provider Identifier
1235759549
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
DO218864 Issued in OR
Practice address
3509 NW Samaritan Dr Ste 215
Corvallis, OR 97330-3893
Phone
(541) 768-5235
NPI assigned
Apr 16, 2020
Last updated
Oct 28, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X PG199038 OR
Psychiatry Physician 2084P0800X DO218864 OR Primary

Addresses

Primary practice location

3509 NW Samaritan Dr Ste 215
Corvallis, OR 97330-3893

Mailing address

PO Box 1189
Corvallis, OR 97339-1189

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jkipperman190894@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
I20240725004488 OR Practitioner - Psychiatry 5092138446 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Col of Osteo Med of the Pacific at Lebanon, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Good Samaritan Hospital CorvallisGroup PAC ID 1557270725, 372 clinicians

Practice addresses (Care Compare)

3509 NW Samaritan Dr
Corvallis, OR 97330-3893

3600 NW Samaritan Dr
Corvallis, OR 97330-3737

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.14 of 100Reported as group
Quality
85.78
Promoting interoperability
100
Improvement activities
40
Cost
78.31

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO218864ORMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Good Samaritan Hospital Corvallis CurrentSince Aug 19, 2024 Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Aug 19, 2024 Accepting new patients
Good Samaritan Hospital Corvallis Current Accepting new patients

Locations

3509 NW Samaritan Dr
Ste 215
Corvallis, OR 97330
Phone (541) 768-5201

3600 NW Samaritan Dr
Corvallis, OR 97330
Phone (541) 768-4906

3600 NW Samaritan Dr
Ste 227
Corvallis, OR 97330
Phone (541) 768-1261

815 NW 9th St
Ste 215
Corvallis, OR 97330
Phone (541) 768-1888

Interoperability endpoints

  • Direct secure messaging: jkipperman190894@samhealth.direct-ci.com

Organizations & group practices 3

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": "1586995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1235759549",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3509 NW SAMARITAN DR STE 215",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303893",
            "telephone_number": "541-768-5235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIPPERMAN",
        "first_name": "JESSE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-16",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OR",
            "license": "PG199038",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OR",
            "license": "DO218864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jkipperman190894@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "3509 NW Samaritan Dr Ste 215",
            "city": "Corvallis",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973303893",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Corvallis, OR

Sources for this page

Verify at the official NPI Registry.