NPIMap

Organization Active NPI

Oregon Pain Management LLC

  • Anesthesiology Physician
  • Salem, OR
National Provider Identifier
1679936579
Registry record updated May 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
OREGON PAIN MANAGEMENT LLC
Practice address
2480 Liberty St NE Ste 180
Salem, OR 97301-8388
Phone
(503) 881-9459
Fax
(503) 363-4373
NPI assigned
Mar 30, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2022

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

Authorized official

Name
Chonthicha Khomkham
Title
Owner
Phone
(503) 881-9459

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

2480 Liberty St NE Ste 180
Salem, OR 97301-8388

Mailing address

2480 Liberty St NE Ste 180
Salem, OR 97301-8388

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161102002967 OR Part B Supplier - Clinic/Group Practice 4183902695 Receives reassigned benefits from 25 practitioners
Practice locations: Salem, OR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1459296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652313600000",
    "number": "1679936579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2480 LIBERTY ST NE STE 180",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973018388",
            "fax_number": "503-363-4373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2480 LIBERTY ST NE STE 180",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973018388",
            "telephone_number": "503-881-9459",
            "fax_number": "503-363-4373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OREGON PAIN MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-30",
        "last_updated": "2022-05-12",
        "certification_date": "2022-05-12",
        "status": "A",
        "authorized_official_last_name": "KHOMKHAM",
        "authorized_official_first_name": "CHONTHICHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-881-9459"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "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 May 12, 2022; 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.