Individual provider Active NPI

Samantha Jo Santiago, FNP

  • Primary Care Nurse Practitioner
  • Clackamas, OR
National Provider Identifier
1578299772
Registry record updated Sep 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
202207379NP-PP Issued in OR
Practice address
9800 SE Sunnyside Rd
Clackamas, OR 97015-9750
Phone
(800) 813-2000
NPI assigned
Jul 29, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical-Surgical Registered Nurse 163WM0705X 201391395RN OR
Primary Care Nurse Practitioner 363LP2300X 202207379NP-PP OR Primary

Addresses

Primary practice location

9800 SE Sunnyside Rd
Clackamas, OR 97015-9750

Mailing address

500 NE Multnomah St Ste 100
Portland, OR 97232-2031
Phone (800) 813-2000

Other practice location 1

18000 SE Stark St
Portland, OR 97233-4828
Phone (503) 489-0567

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231030002391 OR Practitioner - Nurse Practitioner 8527414341 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

9800 SE Sunnyside Rd
Clackamas, OR 97015-9750
Phone (800) 813-2000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
201391395RNORMDMedical-Surgical Registered Nurse
202207379NP-PPORMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Sep 10, 2023 Accepting new patients
Good News Community Health Center, Inc CurrentSince Jul 1, 2022 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Current Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Sep 10, 2023 Accepting new patients

Locations

9800 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2457

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

500 NE Multnomah St
Ste 100
Portland, OR 97232
Phone (503) 499-5200

18000 SE Stark St
Portland, OR 97233
Phone (503) 489-0567

7201 N Interstate Ave
Portland, OR 97217
Phone (503) 240-4051

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

Interoperability endpoints

  • Direct secure messaging: samantha.santiago.1@17909.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/17909/brand/1/csg/1/fhir/r4

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1659052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757635200000",
    "number": "1578299772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 NE MULTNOMAH ST STE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322031",
            "telephone_number": "800-813-2000",
            "fax_number": "855-524-5255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9800 SE SUNNYSIDE RD",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970159750",
            "telephone_number": "800-813-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18000 SE Stark St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972334828",
            "country_code": "US",
            "telephone_number": "503-489-0567",
            "fax_number": "503-489-0568",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANTIAGO",
        "first_name": "SAMANTHA",
        "middle_name": "JO",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-29",
        "last_updated": "2025-09-12",
        "certification_date": "2025-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "OR",
            "license": "201391395RN",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OR",
            "license": "202207379NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clackamas, OR

Sources for this page

Verify at the official NPI Registry.