NPIMap

Individual provider Active NPI

Brandi L Boller, DO

  • Family Medicine Physician
  • Corvallis, OR
National Provider Identifier
1528034683
Registry record updated Jul 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO203116 Issued in OR
Practice address
777 NW 9TH St Ste 320
Corvallis, OR 97330-6169
Phone
(541) 768-1840
NPI assigned
Feb 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DO203116 OR Primary
Family Medicine Physician 207Q00000X 31584 KS

Addresses

Primary practice location

777 NW 9TH St Ste 320
Corvallis, OR 97330-6169

Mailing address

815 NW 9TH St Ste 215
Corvallis, OR 97330-6173

Other practice location 1

2020 Capitol St NE
Salem, OR 97301-0698
Phone (503) 399-2424

Other identifiers 1

IdentifierTypeStateIssuer
103827OtherKSBLUE CROSS/BLUE SHIELD

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bboller240087@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
I20210429001233 OR Practitioner - Family Practice 6901871565 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Good Samaritan Hospital Corvallis 372 clinicians

Practice addresses (Care Compare)

3600 NW Samaritan Dr
Corvallis, OR 97330-3737

777 NW 9TH St
Suite 320
Corvallis, OR 97330-6169
Phone (541) 768-1840

Hospital & facility affiliations

  • Signature Healthcare at Home Home health agency, Eugene, OR, CCN 387140
  • Good Samaritan Regional Medical Center Hospital, Corvallis, OR, CCN 380014
  • Samaritan Albany General Hospital Hospital, Albany, OR, CCN 380022
  • Samaritan Lebanon Community Hospital Hospital, Lebanon, OR, CCN 381323
  • Samaritan Pacific Community Hospital Hospital, Newport, OR, CCN 381314

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
31584KSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Good Samaritan Hospital Corvallis Current Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Aug 1, 2022 Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Aug 1, 2022 Accepting new patients

Locations

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

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

777 NW 9th St
Ste 320
Corvallis, OR 97330
Phone (541) 768-1840

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

Organizations & group practices 8

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 67

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

View all 67

NPI Registry JSON

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658188800000",
    "number": "1528034683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 NW 9TH ST STE 215",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973306173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 NW 9TH ST STE 320",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973306169",
            "telephone_number": "541-768-1840"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2020 Capitol St NE",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973010698",
            "country_code": "US",
            "telephone_number": "503-399-2424",
            "fax_number": "503-375-7432",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLLER",
        "first_name": "BRANDI",
        "middle_name": "L",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-27",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO203116",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "31584",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "103827",
            "state": "KS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bboller240087@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "777 NW 9th St Ste 320",
            "city": "Corvallis",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973306169",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Corvallis, OR

Sources for this page

Verify at the official NPI Registry.