Active NPI
Vanessa Kelly Mizak, FNP-C, AGCNS-BC
- Nurse Practitioner
- Corvallis, OR
National Provider Identifier
1669860979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 201804760NP-PP
- Practice address
- 3600 NW Samaritan Dr Ste 227
Corvallis, OR 97330-3737 - Phone
- (541) 768-1261
- NPI assigned
- Jan 8, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 0993810 | CO | |
| Clinical Nurse Specialist | 364S00000X | 201804762CNS | OR | |
| Clinical Nurse Specialist | 364S00000X | APN.0991563-CNS | CO | |
| Nurse Practitioner | 363L00000X | 201804760NP-PP | OR | Primary |
Addresses
Primary practice location
3600 NW Samaritan Dr Ste 227
Corvallis, OR 97330-3737
Mailing address
PO Box 1189
Corvallis, OR 97339-1189
Other practice location 1
3680 NW Samaritan Dr
Corvallis, OR 97330
Phone (541) 754-1150
Other practice location 2
3640 NW Samaritan Dr Ste 110
Corvallis, OR 97330-3787
Phone (541) 768-1261
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 85780073 | Medicaid | CO | |
| P01618686 | Other | CO | MCR RAILROAD |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | vmizak201575@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: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
3600 NW Samaritan Dr
Corvallis, OR 97330-3737
3640 NW Samaritan Dr
Suite 210
Corvallis, OR 97330-3787
Phone (541) 768-5810
Hospital & facility affiliations
- Good Samaritan Regional Medical Center
- Samaritan Pacific Community Hospital
- Samaritan Albany General Hospital
- Samaritan Lebanon Community Hospital
- Samaritan North Lincoln Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 91.14 of 100
- Quality
- 85.78
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 78.31
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.65 of 100
- Quality
- 86.8
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 86.36
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Specialist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0993810 | CO | MD | Family Nurse Practitioner |
| 201804762CNS | OR | MD | Clinical Nurse Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Good Samaritan Hospital Corvallis | Current | Accepting new patients | |
| Good Samaritan Hospital Corvallis | Current | Accepting new patients | |
| Good Samaritan Hospital Corvallis | Current | Accepting new patients |
Locations
3600 NW Samaritan Dr
Ste 227
Corvallis, OR 97330
Phone (541) 768-1261
3600 NW Samaritan Dr
Corvallis, OR 97330
Phone (541) 768-4906
444 NW Elks Dr
Corvallis, OR 97330
Phone (541) 754-1256
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 and National Provider Directory roles.
-
- General Acute Care Hospital
- Corvallis, OR
- NPI 1962453134
-
- Family Medicine Physician
- Corvallis, OR
- NPI 1427323690
-
- Gynecologic Oncology Physician
- Corvallis, OR
- NPI 1710787916
Hospital & facility affiliations 74
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Albany, OR
- NPI 1154372340
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Albany, OR
- NPI 1326755158
Hospital
-
- Endocrinology, Diabetes & Metabolism Physician
- Albany, OR
- NPI 1346620408
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1420675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631491200000",
"number": "1669860979",
"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": "3600 NW SAMARITAN DR STE 227",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973303737",
"telephone_number": "541-768-1261"
}
],
"practiceLocations": [
{
"address_1": "3680 NW Samaritan Dr",
"address_purpose": "LOCATION",
"city": "Corvallis",
"state": "OR",
"postal_code": "97330",
"country_code": "US",
"telephone_number": "541-754-1150",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3640 NW Samaritan Dr Ste 110",
"address_purpose": "LOCATION",
"city": "Corvallis",
"state": "OR",
"postal_code": "973303787",
"country_code": "US",
"telephone_number": "541-768-1261",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MIZAK",
"first_name": "VANESSA",
"middle_name": "KELLY",
"name_prefix": "Mrs.",
"credential": "FNP-C, AGCNS-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-08",
"last_updated": "2021-09-13",
"certification_date": "2021-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CO",
"license": "0993810",
"primary": false
},
{
"code": "364S00000X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist",
"state": "OR",
"license": "201804762CNS",
"primary": false
},
{
"code": "364S00000X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist",
"state": "CO",
"license": "APN.0991563-CNS",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "OR",
"license": "201804760NP-PP",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "85780073",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCR RAILROAD",
"identifier": "P01618686",
"state": "CO"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "vmizak201575@samhealth.direct-ci.com",
"affiliation": "N",
"address_1": "3600 NW Samaritan Dr Ste 227",
"city": "Corvallis",
"state": "OR",
"country_code": "US",
"postal_code": "973303737",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Corvallis, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.