NPIMap

Individual provider Active NPI

Carly Ann Mayumi Crider, DO

  • Internal Medicine Physician
  • Lebanon, OR
National Provider Identifier
1487041687
Registry record updated Jul 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
193425 Issued in OR
Practice address
400 N Santiam Hwy
Lebanon, OR 97355
Phone
(541) 451-6413
NPI assigned
Apr 25, 2015
Last updated
Jul 30, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 193425 OR Primary

Addresses

Primary practice location

400 N Santiam Hwy
Lebanon, OR 97355

Mailing address

PO Box 1193
Corvallis, OR 97339-1193

Other practice location 1

100 Mullins Dr Ste C2
Lebanon, OR 97355-2868
Phone (541) 451-6413

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ccrider174991@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
I20191001000470 OR Practitioner - Internal Medicine 4981998929 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2016
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

Merit-based Incentive Payment System (MIPS)

Final score
96.77 of 100Reported as group
Quality
88.09
Promoting interoperability
100
Improvement activities
40
Cost
84.48

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
193425ORMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-Valley Healthcare, Inc. CurrentSince Aug 4, 2024 Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Sep 16, 2019 Accepting new patients
Mid-Valley Healthcare, Inc. CurrentSince Nov 7, 2020 Accepting new patients
Mid-Valley Healthcare Inc Current Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Sep 16, 2019 Accepting new patients
Mid-Valley Healthcare Inc CurrentSince Nov 7, 2020 Accepting new patients
Good Samaritan Hospital Corvallis Current Accepting new patients

Locations

3521 NW Samaritan Dr
Ste 201
Corvallis, OR 97330
Phone (541) 768-5140

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

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

100 Mullins Dr
Ste C2
Lebanon, OR 97355
Phone (541) 451-6388

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

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

Interoperability endpoints

  • Direct secure messaging: ccrider174991@samhealth.direct-ci.com

Organizations & group practices 7

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.

Hospital & facility affiliations 36

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

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1429920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722297600000",
    "number": "1487041687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1193",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391193"
        },
        {
            "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": "100 Mullins Dr Ste C2",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "OR",
            "postal_code": "973552868",
            "country_code": "US",
            "telephone_number": "541-451-6413",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRIDER",
        "first_name": "CARLY ANN",
        "middle_name": "MAYUMI",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-25",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "193425",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ccrider174991@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.