NPIMap

Organization Active NPI

Aeg Oregon Professional LLC

  • Optometrist
  • Salem, OR
National Provider Identifier
1679253397
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
AEG OREGON PROFESSIONAL LLC
Practice address
990 Broadway St NE Ste 100
Salem, OR 97301-1396
Phone
(503) 364-0767
NPI assigned
Jul 18, 2023
Last updated
Jun 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

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

Authorized official

Name
Melissa K Allison
Title
Sr. Director RCM/MVC
Phone
(314) 741-8183

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

990 Broadway St NE Ste 100
Salem, OR 97301-1396

Mailing address

111 E 4TH St Ste 440
Alton, IL 62002-6206
Phone (618) 462-9818

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240517000640 OR Part B Supplier - Clinic/Group Practice 5092156364 Receives reassigned benefits from 14 practitioners
Practice locations: Bend, OR; Canby, OR; Hermiston, OR; Portland, OR

National Provider Directory

National Provider Directory

Locations

364 N Ivy St
Canby, OR 97013
Phone (503) 266-4847

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1689638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718841600000",
    "number": "1679253397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E 4TH ST STE 440",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026206",
            "telephone_number": "618-462-9818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 BROADWAY ST NE STE 100",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973011396",
            "telephone_number": "503-364-0767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AEG OREGON PROFESSIONAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-18",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A",
        "authorized_official_last_name": "ALLISON",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "SR. DIRECTOR RCM/MVC",
        "authorized_official_telephone_number": "314-741-8183"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.