NPIMap

Individual provider Active NPI

Dzhakhan Pecherskaya, M.D.

  • Internal Medicine Physician
  • Corvallis, OR
National Provider Identifier
1285998047
Registry record updated Nov 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD178989 Issued in OR
Practice address
3600 NW Samaritan Dr
Corvallis, OR 97330-3737
Phone
(541) 768-5111
NPI assigned
Jun 26, 2012
Last updated
Nov 11, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Internal Medicine Physician 207R00000X MD178989 OR Primary
Hospitalist Physician 208M00000X MD178989 OR

Addresses

Primary practice location

3600 NW Samaritan Dr
Corvallis, OR 97330-3737

Mailing address

PO Box 1189
Corvallis, OR 97339-1189

Other identifiers 1

IdentifierTypeStateIssuer
500714985MedicaidOR

Other names 1

  • Dr. Dzhakhan Zulfugar Kyzy Gasanova Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dpecherskaya130916@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
I20161020001481 OR Practitioner - Internal Medicine 7618282799 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Good Samaritan Hospital CorvallisGroup PAC ID 1557270725, 372 clinicians

Practice addresses (Care Compare)

3600 NW Samaritan Dr
Suite 227
Corvallis, OR 97330-3737
Phone (541) 768-1261

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 Medicine

State licenses

LicenseStateTypeSpecialty
MD178989ORMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Albany General Hospital Current Accepting new patients
Samaritan Pacific Health Services, Inc CurrentSince Mar 20, 2020 Accepting new patients
Samaritan Pacific Health Services, Inc. Current Accepting new patients
Albany General Hospital CurrentSince Mar 20, 2020 Accepting new patients
Samaritan North Lincoln Hospital CurrentSince Mar 20, 2020 Accepting new patients
Mid-Valley Healthcare, Inc. CurrentSince Mar 20, 2020 Accepting new patients
Mid-Valley Healthcare Inc Current Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Oct 1, 2016 Accepting new patients
Mid-Valley Healthcare Inc CurrentSince Mar 20, 2020 Accepting new patients
Samaritan Pacific Health Services, Inc Current Accepting new patients
Samaritan North Lincoln Hospital CurrentSince Mar 20, 2020 Accepting new patients
Albany General Hospital CurrentSince Mar 20, 2020 Accepting new patients
Good Samaritan Hospital Corvallis Current Accepting new patients
Samaritan Pacific Health Services Inc CurrentSince Mar 20, 2020 Accepting new patients

Locations

705 Elm St SW
Ste 200
Albany, OR 97321
Phone (541) 812-4850

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

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

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

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

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

930 SW Abbey St
Newport, OR 97365
Phone (541) 265-2244

Interoperability endpoints

  • Direct secure messaging: dpecherskaya130916@samhealth.direct-ci.com

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 66

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

View all 66

NPI Registry JSON

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

{
    "created_epoch": "1340668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605052800000",
    "number": "1285998047",
    "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": "3600 NW SAMARITAN DR",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303737",
            "telephone_number": "541-768-5111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECHERSKAYA",
        "first_name": "DZHAKHAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-26",
        "last_updated": "2020-11-11",
        "certification_date": "2020-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD178989",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OR",
            "license": "MD178989",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500714985",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dpecherskaya130916@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "3600 NW Samaritan Dr",
            "city": "Corvallis",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973303737",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "DZHAKHAN",
            "last_name": "GASANOVA",
            "middle_name": "ZULFUGAR KYZY",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Corvallis, OR

Sources for this page

Verify at the official NPI Registry.