NPIMap

Organization Active NPI

Mid-Valley Healthcare, Inc.

Doing business as Park Street Clinic

  • Rural Health Clinic/Center
  • Lebanon, OR
National Provider Identifier
1427315662
Registry record updated Dec 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MID-VALLEY HEALTHCARE, INC.
Doing business as
Park Street Clinic
Samaritan Health Clinic - Park St.
Practice address
325 Park St
Lebanon, OR 97355-4229
Phone
(541) 451-7200
NPI assigned
Apr 12, 2012
Last updated
Dec 8, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2025

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

Authorized official

Name
Daniel Rackham
Title
Ceo - SLCH
Phone
(541) 451-7914

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

325 Park St
Lebanon, OR 97355-4229

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
500651505MedicaidOR

Other names 2

  • Park Street Clinic Doing business as
  • Samaritan Health Clinic - Park St. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031111000297 OR Part B Supplier - Clinic/Group Practice 2769391523 Receives reassigned benefits from 458 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lebanon, OR; Sweet Home, OR; Newport, OR; Halsey, OR; Brownsville, OR
O20061104000140 OR Part A Provider - Critical Access Hospital 2769391523 Receives reassigned benefits from 421 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lebanon, OR; Sweet Home, OR
O20180419002734 OR Part A Provider - Rural Health Clinic 2769391523 Practice locations: Lebanon, OR

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1427315662. Details of each certification follow.

Hospital certification: CCN 381323

Legal name
MID-VALLEY HEALTHCARE INC
Doing business as
SAMARITAN LEBANON COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jun 1, 2005
Last certification
Jun 8, 2006
Beds
49 (25 certified)
Ownership / control type
Church
Organization structure
CorporationNon-profit
Incorporated
Jun 5, 1950 in OR
Enrollment address
525 N Santiam Hwy
Lebanon, OR 97355-4363
Other Hospital Practice Location

Rural health clinic certification: CCN 388540

Legal name
MID-VALLEY HEALTHCARE INC
Doing business as
SAMARITAN HEALTH CLINIC - PARK ST
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 16, 2018
Last certification
Nov 17, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jun 5, 1950 in OR
Enrollment address
325 Park St
Lebanon, OR 97355-4229
Related CCNs
381323

Facilities connected through Provider of Services related, parent or unit certification numbers.

View all 15

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 29

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 29

Care Compare: Hospital

Medicare Care Compare
Listed as
Samaritan Lebanon Community HospitalCCN 381323 · All quality measures
Overall star rating
3 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D0626177Samaritan Health Clinic-Park St325 Park Street, Lebanon, OR 97355Certificate of waiverJul 21, 2028

National Provider Directory

National Provider Directory

Locations

675 N 5th St
Lebanon, OR 97355
Phone (541) 451-6282

Ownership & related parties

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Robert Adams Individual Corporate DirectorSecretary Jan 1, 2016
Corporate DirectorBoard of Director Jan 1, 2016
Rachel Hankins Individual Corporate DirectorBoard Member Oct 9, 2018
Samaritan Health Services Inc. Organization, Corvallis, OR Non-profit Operational/Managerial Control Jan 1, 1997 100%
Richard C Evans Individual Corporate DirectorGM Chair Jan 1, 2021
Corporate OfficerBoard of Director Jan 1, 2018
Marsha Philpott Individual Corporate DirectorBoard Member Jan 1, 2015
Corporate DirectorBoard of Director Jan 1, 2015
Mirabelle Fernandes Paul Individual Corporate DirectorBoard Member Jan 1, 2025
Loren Roth Individual Corporate DirectorTreasurer Jan 1, 2015
Corporate DirectorBoard of Director Jan 1, 2015
Joseph Cahill Individual Corporate OfficerCeo Dec 15, 2015 100%
W-2 Managing Employee Dec 15, 2015
Corporate OfficerCeo Dec 31, 2008 100%
W-2 Managing EmployeeCeo Jun 1, 2018
Andrew Wimer Individual Corporate DirectorBoard Member Jun 25, 2024
Vanessa R Papalazaros Individual Corporate Director Jan 1, 2025
Wendie Wunderwald Individual Corporate DirectorBoard Member Jan 1, 2025
Jennifer Kimberlain Individual Corporate OfficerCeo/Administrator - SLCH Mar 9, 2026
W-2 Managing EmployeeAd; Mar 9, 2026
Operational/Managerial ControlCeo/Administrator - SLCH Mar 9, 2026
Corporate DirectorCeo/Administrator - SLCH Mar 9, 2026
Richard C Wopat Individual Corporate DirectorBoard Member Jan 1, 2021
Linn Armstrong Individual Corporate DirectorBoard Member Jan 1, 2016
Corporate DirectorBoard of Director Jan 1, 2016
Randy Springer Individual Corporate DirectorPresident Jan 1, 2017
Corporate DirectorBoard of Director Jan 1, 2017
Brent Kauffman Individual Corporate DirectorBoard Member Jan 1, 2017
Corporate DirectorBoard of Director Jan 1, 2017
Paula M Crone Individual Corporate DirectorBoard Member Dec 11, 2018
Daniel Burton Smith Individual Corporate OfficerVice President Finance/Cfo Apr 24, 2003
Corporate OfficerVice President Finance/Cfo Jan 1, 2000 100%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 21

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 21

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 28

Affiliated clinicians 430

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 430

NPI Registry JSON

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

{
    "created_epoch": "1334188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765152000000",
    "number": "1427315662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 PARK ST",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973554229",
            "telephone_number": "541-451-7200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 PARK ST",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973554229",
            "telephone_number": "541-451-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-VALLEY HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-12",
        "last_updated": "2025-12-08",
        "certification_date": "2025-12-08",
        "status": "A",
        "authorized_official_last_name": "RACKHAM",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "CEO - SLCH",
        "authorized_official_telephone_number": "541-451-7914"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500651505",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Street Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Samaritan Health Clinic - Park St.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lebanon, OR

Sources for this page

Verify at the official NPI Registry.