Individual provider Active NPI

Amanda Greene

  • Registered Dietitian
  • Corvallis, OR
National Provider Identifier
1265917629
Registry record updated Jun 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
LD-D-10194322 Issued in OR
Practice address
3517 NW Samaritan Dr Ste 100
Corvallis, OR 97330-3768
Phone
(541) 768-4280
NPI assigned
Oct 1, 2018
Last updated
Jun 19, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 1036547 OR
Registered Dietitian 133V00000X LD-D-10194322 OR Primary

Addresses

Primary practice location

3517 NW Samaritan Dr Ste 100
Corvallis, OR 97330-3768

Mailing address

PO Box 1189
Corvallis, OR 97339-1189

Other practice location 1

794 Arrow Leaf Pl
Harrisburg, OR 97446-9684
Phone (541) 525-9554

Other practice location 2

794 Arrow Leaf Pl
Harrisburg, OR 97446-9684
Phone (541) 525-9554

Other practice location 3

3377 Riverbend Dr
Springfield, OR 97477
Phone (541) 222-2700

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address agreene291245@samhealth.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190129003480 OR Practitioner - Registered Dietitian Or Nutrition Professional 5193062198 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2008
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)

3517 NW Samaritan Dr
Corvallis, OR 97330-3768

3600 NW Samaritan Dr
Corvallis, OR 97330-3737

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1036547ORMDRegistered Dietitian
LD-D-10194322ORMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Good Samaritan Hospital Corvallis CurrentSince Apr 29, 2024 Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Apr 29, 2024 Accepting new patients
Good Samaritan Hospital Corvallis Current Accepting new patients

Locations

3517 NW Samaritan Dr
Ste 100
Corvallis, OR 97330
Phone (541) 768-4280

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

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.

NPI Registry JSON

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

{
    "created_epoch": "1538352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718755200000",
    "number": "1265917629",
    "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": "3517 NW SAMARITAN DR STE 100",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303768",
            "telephone_number": "541-768-4280"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "794 Arrow Leaf Pl",
            "address_purpose": "LOCATION",
            "city": "Harrisburg",
            "state": "OR",
            "postal_code": "974469684",
            "country_code": "US",
            "telephone_number": "541-525-9554",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "794 Arrow Leaf Pl",
            "address_purpose": "LOCATION",
            "city": "Harrisburg",
            "state": "OR",
            "postal_code": "974469684",
            "country_code": "US",
            "telephone_number": "541-525-9554",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3377 Riverbend Dr",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "OR",
            "postal_code": "97477",
            "country_code": "US",
            "telephone_number": "541-222-2700",
            "fax_number": "541-222-2700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREENE",
        "first_name": "AMANDA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-01",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OR",
            "license": "1036547",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OR",
            "license": "LD-D-10194322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "agreene291245@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "3517 NW Samaritan Dr Ste 100",
            "city": "Corvallis",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973303768",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Corvallis, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2024; 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.