Individual provider Active NPI

Katharine Middendorf, PH.D.

  • Psychologist
  • Corvallis, OR
National Provider Identifier
1619428950
Registry record updated Nov 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
2746 Issued in OR
Practice address
3509 NW Samaritan Dr Ste 215
Corvallis, OR 97330-3893
Phone
(541) 768-5235
NPI assigned
Oct 21, 2016
Last updated
Nov 11, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 2742 OR
Psychologist 103T00000X 2746 OR Primary

Addresses

Primary practice location

3509 NW Samaritan Dr Ste 215
Corvallis, OR 97330-3893

Mailing address

PO Box 1189
Corvallis, OR 97339-1189

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kmiddendorf131617@samhealth.direct-ci.com

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161121001532 OR Practitioner - Clinical Psychologist 3678852357 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Good Samaritan Hospital CorvallisGroup PAC ID 1557270725, 372 clinicians

Practice addresses (Care Compare)

3509 NW Samaritan Dr
Suite 215
Corvallis, OR 97330-3893
Phone (541) 768-5235

Merit-based Incentive Payment System (MIPS)

Final score
91.14 of 100Reported as group
Quality
85.78
Promoting interoperability
100
Improvement activities
40
Cost
78.31

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2742ORMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Good Samaritan Hospital Corvallis CurrentSince Oct 19, 2016 Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Oct 19, 2016 Accepting new patients
Good Samaritan Hospital Corvallis Current Accepting new patients

Locations

3509 NW Samaritan Dr
Corvallis, OR 97330
Phone (541) 768-5235

3509 NW Samaritan Dr
Ste 215
Corvallis, OR 97330
Phone (541) 768-5201

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

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1477008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605052800000",
    "number": "1619428950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1189",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3509 NW SAMARITAN DR STE 215",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303893",
            "telephone_number": "541-768-5235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIDDENDORF",
        "first_name": "KATHARINE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-21",
        "last_updated": "2020-11-11",
        "certification_date": "2020-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OR",
            "license": "2742",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OR",
            "license": "2746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmiddendorf131617@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "3509 NW Samaritan Dr Ste 215",
            "city": "Corvallis",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973303893",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Corvallis, OR

Sources for this page

Verify at the official NPI Registry.