Santiam Memorial Hospital
Organization Active NPI Rural Health Clinic/Center · Stayton, OR
NPI 1477909570 · NPPES record last updated Oct 22, 2018
Key facts
- NPI
- 1477909570
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- SANTIAM MEMORIAL HOSPITAL
- Practice address
- 1401 N 10TH Ave
Ste. 100
Stayton, OR 97383-1486 - Phone
- (503) 769-6386
- Fax
- (503) 769-5647
- NPI assigned
- May 6, 2016
- Organization subpart
- No
Authorized official
- Name
- Lynda Fraser
- Title
- Clinic Director
- Phone
- (503) 769-9254
Owners & managing parties with NPI records 2
-
James W Bayuk, MD
-
Steven M Vets, DO
Other NPIs on the same Medicare enrollment 22
Other NPIs with the same Medicare PAC ID 7
Related certifications (CCN) 2
Practitioners 133
-
Ian Cavigli, PA-C
-
Jeffrey Allan Koller, PA-C
-
James Patrick Nealon, M.D.
-
Samantha Pacheco, PA-C
-
Stephanie Ridgley, FNP
-
Michael Bass, PA-C
-
Tricia Raye Hayden, APRN
-
Katie Elizabeth Metzger, PA-C
-
Maxwell B Abbott, M.D.
-
Pedro Abdala, MD
-
Scott Harrison Ambruster, M.D.
-
Tasha Barkley, M. D. M.P.H.
-
John K Bradshaw, M.D.
-
Stephen Leon Burrows, M.D.
-
McKenna Chandler, PA-S
-
Michael C Chen, M.D.
-
Takahla Circle, APRN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OR
Rural health clinic certification: CCN 388535
- Legal name
- SANTIAM MEMORIAL HOSPITAL
- Doing business as
- SANTIAM MEDICAL ASSOCIATES
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Aug 29, 2018
- Last certification
- Aug 20, 2025
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Dec 31, 1951 in OR
- Enrollment address
- 1401 N 10TH Ave
Ste 100
Stayton, OR 97383-1486 - Related CCNs
- 380056
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Melissa Baurer |
Corporate Officer |
Apr 1, 2025 | |
| Silvia Hernandez |
Corporate Director |
Feb 8, 2023 | 11.1% |
| Cassondra Posvar Martinez |
Corporate Officer |
Apr 1, 2025 | |
| W-2 Managing Employee |
Jan 1, 2021 | ||
| Ed Diehl |
Corporate Director |
Apr 12, 2017 | 11.1% |
| Rachael Seeder |
Corporate Officer |
Dec 1, 2020 | |
| Margaret a Hudson |
Corporate Officer |
Jan 25, 1993 | |
| W-2 Managing Employee |
Jan 25, 1993 | ||
| Mike L Odenthal |
Corporate Director |
Mar 11, 1979 | 11.1% |
| Pamela Ray |
Corporate Director |
Jun 12, 2019 | 11.1% |
| Steven M Vets |
Corporate Officer |
Jan 15, 2021 | |
| Tiffanie Pye |
Corporate Officer |
Oct 2, 2023 | |
| W-2 Managing Employee |
Oct 2, 2023 | ||
| James W Bayuk |
Corporate Director |
Feb 11, 2026 | 11.1% |
| Debbie Turrell |
Corporate Officer |
Apr 1, 2025 | |
| Genny Baldwin |
Corporate Director |
Jan 1, 2021 | 11.1% |
| Victor D Kintz |
Corporate Director |
May 12, 2003 | 11.1% |
| Maryann F Meredith |
Corporate Director |
Jun 9, 1998 | 11.1% |
| Emily Newton |
Corporate Director |
Feb 11, 2026 | 11.1% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040130000239 | OR | Part B Supplier - Clinic/Group Practice | 6103729751 |
Receives reassigned benefits from 154 practitioners 22 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Mill City, OR; Aumsville, OR; Sublimity, OR; Stayton, OR |
| O20180328002926 | OR | Part a Provider - Rural Health Clinic | 6103729751 | Practice locations: Stayton, OR |
National Provider Directory
Locations
1375 N 10th Ave
Ste B
Stayton, OR 97383
Phone (503) 769-7546
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
1401 N 10TH Ave
Ste. 100
Stayton, OR 97383-1486
Mailing address
1401 N 10TH Ave
Ste. 100
Stayton, OR 97383-1486
Phone (503) 769-6386
Other names
- Santiam Medical Associates
Other providers in Stayton, OR
- Santiam Memorial Hospital
- Santiam Memorial Hospital
- Santiam Memorial Hospital
- Santiam Memorial Hospital
- Santiam Memorial Hospital
- Santiam Memorial Hospital
- Santiam Memorial Hospital
- Santiam Memorial Hospital
- Santiam Memorial Hospital
- Santiam Memorial Hospital
All providers in Stayton, OR · Rural Health Clinic/Center in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 22, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.