NPIMap

Individual provider Active NPI

Nicole J Bangs, P.A.-C.

  • Surgical Physician Assistant
  • Salem, OR
National Provider Identifier
1336242536
Registry record updated Feb 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA156470 Issued in OR
Practice address
1600 State St
Salem, OR 97301-4257
Phone
(503) 540-6300
Fax
(503) 540-6404
NPI assigned
Sep 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA156470 OR Primary

Addresses

Primary practice location

1600 State St
Salem, OR 97301-4257

Mailing address

1600 State St
Salem, OR 97301-4257
Phone (503) 540-6300

Other identifiers 1

IdentifierTypeStateIssuer
500640158MedicaidOR

Other names 1

  • Nicole J Gallob Former name

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
I20111108000383 OR Practitioner - Physician Assistant 8224035134 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oregon Spine Care LLCGroup PAC ID 4183855604, 5 clinicians
Alexander C Ching MD PCGroup PAC ID 7416322185, 3 clinicians

Practice addresses (Care Compare)

19255 SW 65TH Ave
Suite 200
Tualatin, OR 97062-9712
Phone (503) 828-1150

19255 SW 65TH Ave
Suite 260
Tualatin, OR 97062-7499
Phone (503) 828-1150

Hospital & facility affiliations

  • Legacy Meridian Park Medical Center Hospital, Tualatin, OR, CCN 380089
  • Providence Willamette Falls Medical Center Hospital, Oregon City, OR, CCN 380038
  • Providence St Vincent Medical Center Hospital, Portland, OR, CCN 380004
  • Providence Newberg Medical Center Hospital, Newberg, OR, CCN 380037
  • Legacy Silverton Medical Center Hospital, Silverton, OR, CCN 380029

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1094MNMDAcupuncturist
10387MNMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Alexander C Ching MD PC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: nicole.bangs@1621.securemail.prognocis.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392249600000",
    "number": "1336242536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 STATE ST",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973014257",
            "telephone_number": "503-540-6300",
            "fax_number": "503-540-6404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 STATE ST",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973014257",
            "telephone_number": "503-540-6300",
            "fax_number": "503-540-6404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANGS",
        "first_name": "NICOLE",
        "middle_name": "J",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-06",
        "last_updated": "2014-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OR",
            "license": "PA156470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500640158",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "GALLOB",
            "middle_name": "J",
            "credential": "P.A.-C.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.