NPIMap

Organization Active NPI

Cascade Cardiology LLC

  • Cardiovascular Disease Physician
  • Salem, OR
National Provider Identifier
1548545817
Registry record updated Oct 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
CASCADE CARDIOLOGY LLC
Practice address
777 Commercial St SE
Suite 130
Salem, OR 97301-3421
Phone
(503) 485-4787
Fax
(203) 485-4789
NPI assigned
Oct 18, 2011
Last updated
Oct 19, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
CASCADE CARDIOLOGY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 19, 2011

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

Authorized official

Name
Helen C Wigstrom
Title
Credentailing Specialist
Phone
(503) 485-4787

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU
Cardiovascular Disease Physician 207RC0000X NU Primary
Clinical Cardiac Electrophysiology Physician 207RC0001X NU
Interventional Cardiology Physician 207RI0011X NU

Addresses

Primary practice location

777 Commercial St SE
Suite 130
Salem, OR 97301-3421

Mailing address

777 Commercial St SE
Suite 130
Salem, OR 97301-3421
Phone (503) 485-4787

Other names 1

  • Cascade Cardiology Portland Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040408001518 OR Part B Supplier - Clinic/Group Practice 2466446844 Receives reassigned benefits from 6 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Salem, OR; Woodburn, OR; Stayton, OR; Silverton, OR; Portland, OR; McMinnville, OR

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Cascade Cardiology LLC2 organizations share this tax ID, including this one
Part of
Cascade Cardiology LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

875 Oak St SE
Ste 5080
Salem, OR 97301
Phone (503) 485-4787

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1318896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318982400000",
    "number": "1548545817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 COMMERCIAL ST SE",
            "address_2": "SUITE 130",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013421",
            "telephone_number": "503-485-4787",
            "fax_number": "203-485-4789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 COMMERCIAL ST SE",
            "address_2": "SUITE 130",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013421",
            "telephone_number": "503-485-4787",
            "fax_number": "203-485-4789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASCADE CARDIOLOGY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CASCADE CARDIOLOGY LLC",
        "enumeration_date": "2011-10-18",
        "last_updated": "2011-10-19",
        "status": "A",
        "authorized_official_last_name": "WIGSTROM",
        "authorized_official_first_name": "HELEN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CREDENTAILING SPECIALIST",
        "authorized_official_telephone_number": "503-485-4787"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cascade Cardiology Portland",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.