NPIMap

Individual provider Active NPI

Kerry Lynne Kreidel, M.D.

  • Anesthesiology Physician
  • Corvallis, OR
National Provider Identifier
1639351893
Registry record updated Jul 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
R0051 Issued in TX
Practice address
Good Samaritan Regional Medical Center
3600 NW Samaritan Dr
Corvallis, OR 97330
Phone
(541) 768-5111
NPI assigned
Nov 29, 2007
Last updated
Jul 24, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2023

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X DR.0070496 CO
Anesthesiology Physician 207L00000X 21926 NV
Anesthesiology Physician 207L00000X 44732 AZ
Anesthesiology Physician 207L00000X MD216184 OR
Anesthesiology Physician 207L00000X R0051 TX Primary

Addresses

Primary practice location

Good Samaritan Regional Medical Center
3600 NW Samaritan Dr
Corvallis, OR 97330

Mailing address

9319 Oak Ledge Dr
San Antonio, TX 78217-5127
Phone (520) 343-9236

Other practice location 1

45 NE Loop 410
Suite 900
San Antonio, TX 78216-5832
Phone (210) 375-7790

Other names 1

  • Kerry McGonigle Kreidel Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kkreidel265451@samhealth.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, VI, OR, CO4 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20161213001794 TX Practitioner - Anesthesiology 3870762719 Reassigns benefits to 2 organizations
I20201118000104 VI Practitioner - Anesthesiology 3870762719 Reassigns benefits to 1 organization
I20230710002754 OR Practitioner - Anesthesiology 3870762719 Reassigns benefits to 2 organizations
I20250717002528 CO Practitioner - Anesthesiology 3870762719 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boulder Valley Anesthesiology, PLLCGroup PAC ID 7113830993, 61 clinicians

Practice addresses (Care Compare)

4747 Arapahoe Ave
Boulder, CO 80303-1131
Phone (303) 415-7000

Hospital & facility affiliations

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 Medicine

State licenses

LicenseStateTypeSpecialty
44732AZMDAnesthesiology Physician
DR.0070496COMDAnesthesiology Physician
R0051TXMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
U S Anesthesia Partners of Texas, PA Anesthesiology CurrentSince Sep 3, 2019 Accepting new patients
Cep America - Anesthesia PC Anesthesiology CurrentSince Nov 18, 2024 Accepting new patients
Cep America - Anesthesia PC Anesthesiology CurrentSince Nov 18, 2024 Accepting new patients
Oregon Anesthesiology Group PC Anesthesiology CurrentSince Jun 21, 2023 Accepting new patients
U. S. Anesthesia Partners of Texas, P.a., Anesthesiology CurrentSince Sep 3, 2019 Accepting new patients
Tejas Anesthesia PLLC Anesthesiology CurrentSince May 20, 2017 Accepting new patients
Tejas Anesthesia PLLC Anesthesiology CurrentSince May 20, 2017 Accepting new patients
Governor Juan F. Luis Hospital & Medical Center CurrentSince Oct 25, 2020 Accepting new patients
Boulder Valley Anesthesiology, PLLC Anesthesiology CurrentSince Jul 8, 2025 Accepting new patients
Governor Juan F. Luis Hospital & Medical Center CurrentSince Oct 25, 2020 Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

1100 Balsam Ave
Boulder, CO 80304
Phone (303) 415-7000

4450 Arapahoe Ave
Ste 100
Boulder, CO 80303
Phone (303) 415-2532

4747 Arapahoe Ave
Boulder, CO 80303
Phone (303) 415-7000

10170 Church Ranch Way
Westminster, CO 80021
Phone (303) 328-3400

235 W 6th St
Reno, NV 89503
Phone (775) 746-3202

3600 NW Samaritan Dr
Corvallis, OR 97330
Phone (541) 768-4906

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

707 SW Washington St
Portland, OR 97205

707 SW Washington St
Ste 700
Portland, OR 97205

2700 NW Stewart Pkwy
Roseburg, OR 97471
Phone (541) 673-0611

1445 State St
Salem, OR 97301
Phone (503) 315-7338

100 Medical Dr
Lake Jackson, TX 77566
Phone (713) 496-7555

2240 Gulf Fwy S
League City, TX 77573
Phone (832) 505-1000

4242 Medical Dr
Ste 1260
San Antonio, TX 78229
Phone (210) 477-9551

4242 Medical Dr
Ste 3100
San Antonio, TX 78229
Phone (210) 477-9555

9250 Pinecroft Dr
Shenandoah, TX 77380
Phone (281) 364-2300

4007 Estate Diamond Ruby
St Croix, VI 00820
Phone (340) 772-7423

Interoperability endpoints

  • Direct secure messaging: kkreidel265451@samhealth.direct-ci.com

Organizations & group practices 10

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.

Hospital & facility affiliations 34

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

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1196294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690156800000",
    "number": "1639351893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9319 OAK LEDGE DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782175127",
            "telephone_number": "520-343-9236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "GOOD SAMARITAN REGIONAL MEDICAL CENTER",
            "address_2": "3600 NW SAMARITAN DR",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "97330",
            "telephone_number": "541-768-5111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "45 NE Loop 410",
            "address_2": "SUITE 900",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782165832",
            "country_code": "US",
            "telephone_number": "210-375-7790",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KREIDEL",
        "first_name": "KERRY",
        "middle_name": "LYNNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-29",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CO",
            "license": "DR.0070496",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NV",
            "license": "21926",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AZ",
            "license": "44732",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OR",
            "license": "MD216184",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TX",
            "license": "R0051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kkreidel265451@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "Good Samaritan Regional Medical Center",
            "address_2": "3600 NW Samaritan Dr",
            "city": "Corvallis",
            "state": "OR",
            "country_code": "US",
            "postal_code": "97330",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KERRY",
            "last_name": "KREIDEL",
            "middle_name": "MCGONIGLE",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Corvallis, OR

Sources for this page

Verify at the official NPI Registry.