NPIMap

Individual provider Active NPI

Subeena Pritam Phull, MD

  • Internal Medicine Physician
  • Lebanon, OR
National Provider Identifier
1386206332
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD218933 Issued in OR
Practice address
400 N Santiam Hwy
Lebanon, OR 97355
Phone
(541) 451-6413
NPI assigned
Jun 30, 2019
Sex
Female
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
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X MD218933 OR Primary

Addresses

Primary practice location

400 N Santiam Hwy
Lebanon, OR 97355

Mailing address

PO Box 1189
Corvallis, OR 97339-1189

Other practice location 1

201 E University Pkwy Dept Of
Baltimore, MD 21218-2829
Phone (410) 554-2782

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sphull302262@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
I20240514003890 OR Practitioner - Internal Medicine 0446691976 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mid-Valley Healthcare IncGroup PAC ID 2769391523, 143 clinicians

Practice addresses (Care Compare)

325 Park St
Lebanon, OR 97355-4229
Phone (541) 451-7200

425 N Santiam Hwy
Lebanon, OR 97355-4361

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD218933ORMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-Valley Healthcare Inc Current Accepting new patients
Mid-Valley Healthcare, Inc. CurrentSince Nov 3, 2024 Accepting new patients
Mid-Valley Healthcare Inc CurrentSince Jul 1, 2024 Accepting new patients
Mid-Valley Healthcare Inc CurrentSince Jul 1, 2024 Accepting new patients

Locations

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

400 N Santiam Hwy
Lebanon, OR 97355
Phone (541) 451-6388

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

Interoperability endpoints

  • Direct secure messaging: sphull302262@samhealth.direct-ci.com

Organizations & group practices 4

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 37

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

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1561852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1386206332",
    "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": "400 N SANTIAM HWY",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "97355",
            "telephone_number": "541-451-6413"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 E University Pkwy Dept Of",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212182829",
            "country_code": "US",
            "telephone_number": "410-554-2782",
            "fax_number": "443-444-3430",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHULL",
        "first_name": "SUBEENA",
        "middle_name": "PRITAM",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-30",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD218933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sphull302262@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "400 N Santiam HWY",
            "city": "Lebanon",
            "state": "OR",
            "country_code": "US",
            "postal_code": "97355",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lebanon, OR

Sources for this page

Verify at the official NPI Registry.