NPIMap

Organization Active NPI

Samaritan Pacific Health Services, Inc.

Doing business as Samaritan Health Clinic - Waldport

  • Rural Health Clinic/Center
  • Waldport, OR
National Provider Identifier
1619047503
Registry record updated Nov 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SAMARITAN PACIFIC HEALTH SERVICES, INC.
Doing business as
Samaritan Health Clinic - Waldport
Samaritan Waldport Clinic
Practice address
920 SW Range Drive
Waldport, OR 97394-3035
Phone
(541) 563-3197
NPI assigned
Nov 8, 2006
Last updated
Nov 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2025

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

Authorized official

Name
Mr. Lesley Ogden, MD
Title
Ceo
Phone
(541) 996-7100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

920 SW Range Drive
Waldport, OR 97394-3035

Mailing address

PO Box 2847
Corvallis, OR 97339-2847
Phone (541) 563-3197

Other identifiers 1

IdentifierTypeStateIssuer
286758MedicaidOR

Other names 2

  • Samaritan Health Clinic - Waldport Doing business as
  • Samaritan Waldport Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040204000304 OR Part B Supplier - Clinic/Group Practice 2466353529 Receives reassigned benefits from 384 practitioners
25 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Newport, OR; Depoe Bay, OR
O20150512002971 OR Part A Provider - Rural Health Clinic 2466353529 Practice locations: Waldport, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619047503. Details of each certification follow.

Rural health clinic certification: CCN 388519

Legal name
SAMARITAN PACIFIC HEALTH SERVICES INC
Doing business as
SAMARITAN HEALTH CLINIC - WALDPORT
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 23, 2015
Last certification
Jun 15, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 8, 1948 in OR
Enrollment address
920 SW Range Dr
Waldport, OR 97394-9634
Related CCNs
381314

Facilities connected through Provider of Services related, parent or unit certification numbers.

View all 13

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 24

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

View all 24

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D0860197Samaritan Health Clinic - Waldport920 SW Range Dr, Waldport, OR 97394Certificate of waiverJan 31, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Samaritan Health Services Inc. Organization, Corvallis, OR Corporation Operational/Managerial Control Jan 1, 2012 100%
Kelley Kaiser Individual Corporate DirectorBoard Member Dec 31, 2019
Jerry J Robbins Individual Corporate DirectorBoard Member Jan 1, 2012
Samaritan Pacific Health Services Inc Organization, Newport, OR Non-profit Operational/Managerial Control Jan 1, 2012 100%
Ursula Marinelli Individual Corporate DirectorBoard Member Apr 1, 2025
Stephen M Burns Individual Corporate DirectorBoard Member Jan 1, 2003
Lesley J Ogden Individual Corporate OfficerCeo Dec 23, 2016 100%
W-2 Managing Employee Dec 23, 2016
Matthew Updenkelder Individual Corporate DirectorBoard Member Apr 1, 2025
Ralph Breitenstein Individual Corporate DirectorSecretary Nov 21, 2013
Daniel Burton Smith Individual Corporate OfficerVice President Finance/Cfo- SHS Jan 1, 2000 100%
Operational/Managerial ControlVice President Finance/Cfo- SHS Jan 1, 2000 100%

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Samaritan Health Clinic - ToledoToledo, OR, CCN 388529 Rural health clinic Operational/Managerial Control (100%) Jan 1, 2012

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 21

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 21

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762128000000",
    "number": "1619047503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2847",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973392847",
            "telephone_number": "541-563-3197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 SW RANGE DRIVE",
            "city": "WALDPORT",
            "state": "OR",
            "postal_code": "973943035",
            "telephone_number": "541-563-3197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMARITAN PACIFIC HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2025-11-03",
        "certification_date": "2025-11-03",
        "status": "A",
        "authorized_official_last_name": "OGDEN",
        "authorized_official_first_name": "LESLEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-996-7100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "286758",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Samaritan Health Clinic - Waldport",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Samaritan Waldport Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waldport, OR

Sources for this page

Verify at the official NPI Registry.