NPIMap

Individual provider Active NPI

Kimberly A Cradock, MD

  • Surgery Physician
  • Corvallis, OR
National Provider Identifier
1659483204
Registry record updated Dec 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD226613 Issued in OR
Practice address
996 NW Circle Blvd Ste 103
Corvallis, OR 97330-1485
Phone
(541) 768-1252
NPI assigned
Aug 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 036116793 IL
Surgery Physician 208600000X MD226613 OR Primary

Addresses

Primary practice location

996 NW Circle Blvd Ste 103
Corvallis, OR 97330-1485

Mailing address

PO Box 1189
Corvallis, OR 97339-1189

Other practice location 1

602 W. University Avenue
General Surgery
Urbana, IL 61801
Phone (217) 383-3240

Other identifiers 1

IdentifierTypeStateIssuer
6447860011MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kcradock338795@samhealth.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, OR2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20061221000388 IL Practitioner - General Surgery 3173523180 Reassigns benefits to 2 organizations
I20251118004250 OR Practitioner - General Surgery 3173523180 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Saint Louis University School of Medicine, 2001
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
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

3600 NW Samaritan Dr
Corvallis, OR 97330-3737

611 W Park St
Urbana, IL 61801-2500

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

996 NW Circle Blvd
Suite 103
Corvallis, OR 97330-1485
Phone (541) 768-4370

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy27
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036116793ILMDSurgery Physician
MD226613ORMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Good Samaritan Hospital Corvallis CurrentSince Dec 1, 2025 Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Dec 1, 2025 Accepting new patients
Hoopeston Community Memorial Hospital Current Accepting new patients
Good Samaritan Hospital Corvallis Current Accepting new patients
Carle Health Care Incorporated CurrentSince Apr 1, 2010 Accepting new patients
Hoopeston Community Memorial Hospital CurrentSince Mar 26, 2010 Accepting new patients
Hoopeston Community Memorial Hospital CurrentSince Mar 26, 2010 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

701 E Orange St
Hoopeston, IL 60942
Phone (217) 283-5531

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

810 W Anthony Dr
Urbana, IL 61802
Phone (217) 326-2911

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

996 NW Circle Blvd
Ste 103
Corvallis, OR 97330
Phone (541) 768-1252

Interoperability endpoints

  • Direct secure messaging: kcradockmd71878@carlehiedirect.net

Organizations & group practices 8

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 68

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

View all 68

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765152000000",
    "number": "1659483204",
    "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": "996 NW CIRCLE BLVD STE 103",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973301485",
            "telephone_number": "541-768-1252"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "602 W. University Avenue",
            "address_2": "General Surgery",
            "address_purpose": "LOCATION",
            "city": "Urbana",
            "state": "IL",
            "postal_code": "61801",
            "country_code": "US",
            "telephone_number": "217-383-3240",
            "fax_number": "217-383-4597",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRADOCK",
        "first_name": "KIMBERLY",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2025-12-08",
        "certification_date": "2025-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036116793",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OR",
            "license": "MD226613",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6447860011",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kcradock338795@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "996 NW Circle Blvd Ste 103",
            "city": "Corvallis",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973301485",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Corvallis, OR

Sources for this page

Verify at the official NPI Registry.