Individual provider Active NPI

Robert Woodruff

  • Family Medicine Physician
  • Lebanon, OR
National Provider Identifier
1619435583
Registry record updated Dec 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DR.0076249 Issued in CO
Practice address
200 Mullins Dr
Lebanon, OR 97355-3983
Phone
(541) 259-0200
NPI assigned
Mar 8, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X DR.0076249 CO Primary

Addresses

Primary practice location

200 Mullins Dr
Lebanon, OR 97355-3983

Mailing address

200 Mullins Dr
Lebanon, OR 97355-3983

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260108001100 CO Practitioner - Family Practice 8022499854 Reassigns benefits to 1 organization

Care Compare profile

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

Practice addresses (Care Compare)

8350 Colorado Blvd
Unit 160
Firestone, CO 80504-6803
Phone (303) 673-1370

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR.0076249COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Medical Group Denver, LLC Multi-Specialty CurrentSince Oct 13, 2025 Accepting new patients
Intermountain Medical Group Denver, LLC Multi-Specialty CurrentSince Oct 13, 2025 Accepting new patients
Western University of Health Sciences Multi-Specialty Past Accepting new patients
Intermountain Medical Group Denver, LLC Multi-Specialty Past Accepting new patients

Locations

12169 Sheridan Blvd
Broomfield, CO 80020
Phone (303) 439-0169

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1552003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764720000000",
    "number": "1619435583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MULLINS DR",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973553983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MULLINS DR",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973553983",
            "telephone_number": "541-259-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODRUFF",
        "first_name": "ROBERT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-08",
        "last_updated": "2025-12-03",
        "certification_date": "2025-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0076249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, OR

Sources for this page

Verify at the official NPI Registry.