NPIMap

Individual provider Active NPI

Devon D Peterson, CRNA

  • Certified Registered Nurse Anesthetist
  • Lincoln City, OR
National Provider Identifier
1245278035
Registry record updated Jul 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
10004847 Issued in OR
Practice address
3043 NE 28TH St
Lincoln City, OR 97367-4518
Phone
(541) 994-3661
NPI assigned
Jun 3, 2006
Last updated
Jul 27, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 53425214406 UT
Certified Registered Nurse Anesthetist 367500000X 10004847 OR Primary

Addresses

Primary practice location

3043 NE 28TH St
Lincoln City, OR 97367-4518

Mailing address

PO Box 1189
Corvallis, OR 97339-1189

Other practice location 1

48 W 1500 N
Nephi, UT 84648-8900
Phone (435) 623-3000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dpeterson254010@samhealth.direct-ci.com

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040419000474 UT Practitioner - Certified Registered Nurse Anesthetist (Crna) 6901891936 Reassigns benefits to 1 organization
I20230426001858 OR Practitioner - Certified Registered Nurse Anesthetist (Crna) 6901891936 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Samaritan North Lincoln HospitalGroup PAC ID 7911816301, 42 clinicians

Practice addresses (Care Compare)

3043 NE 28TH St
Lincoln City, OR 97367-4518
Phone (541) 994-3661

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
92.23
Promoting interoperability
100
Improvement activities
40
Cost
100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
10004847ORMDCertified Registered Nurse Anesthetist
53425214406UTMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Samaritan North Lincoln Hospital CurrentSince May 15, 2023 Accepting new patients
Santiam Memorial Hospital Current Accepting new patients
Samaritan North Lincoln Hospital Current Accepting new patients
Lake Health District CurrentSince Jun 1, 2025 Accepting new patients
Salt Creek Anesthesia PLLC Anesthesiology CurrentSince Jul 1, 2022 Accepting new patients
Santiam Memorial Hospital CurrentSince Jan 6, 2025 Accepting new patients
Santiam Memorial Hospital CurrentSince Jan 6, 2025 Accepting new patients
Samaritan North Lincoln Hospital CurrentSince May 15, 2023 Accepting new patients

Locations

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

700 S J St
Lakeview, OR 97630
Phone (541) 947-2114

3043 NE 28th St
Lincoln City, OR 97367
Phone (541) 994-3661

1375 N 10th Ave
Ste B
Stayton, OR 97383
Phone (503) 769-7546

1401 N 10th Ave
Stayton, OR 97383
Phone (503) 769-2175

48 W 1500 N
Nephi, UT 84648
Phone (435) 623-3000

Interoperability endpoints

  • Direct secure messaging: dpeterson254010@samhealth.direct-ci.com

Organizations & group practices 8

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 8

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

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690416000000",
    "number": "1245278035",
    "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": "3043 NE 28TH ST",
            "city": "LINCOLN CITY",
            "state": "OR",
            "postal_code": "973674518",
            "telephone_number": "541-994-3661"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "48 W 1500 N",
            "address_purpose": "LOCATION",
            "city": "Nephi",
            "state": "UT",
            "postal_code": "846488900",
            "country_code": "US",
            "telephone_number": "435-623-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "DEVON",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "UT",
            "license": "53425214406",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OR",
            "license": "10004847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dpeterson254010@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "3043 NE 28th St",
            "city": "Lincoln City",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973674518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lincoln City, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.