Active NPI
Nicolette Rosendahl, DO
- Internal Medicine Physician
- Corvallis, OR
National Provider Identifier
1689127045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- DO192939
- Practice address
- 3680 NW Samaritan Dr
Corvallis, OR 97330-3737 - Phone
- (541) 754-1260
- NPI assigned
- Aug 2, 2016
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neuromusculoskeletal Medicine & OMM Physician | 204D00000X | DO192939 | OR | |
| Internal Medicine Physician | 207R00000X | R10627 | IA | |
| Internal Medicine Physician | 207R00000X | DO192939 | OR | Primary |
Addresses
Primary practice location
3680 NW Samaritan Dr
Corvallis, OR 97330-3737
Mailing address
444 NW Elks Dr
Corvallis, OR 97330-3745
Phone (541) 754-1150
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: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
3680 NW Samaritan Dr
Corvallis, OR 97330-3737
Phone (541) 754-1150
Hospital & facility affiliations
- Signature Healthcare at Home
- Mission Home Health of Salem
- Good Samaritan Regional Medical Center
- Samaritan Albany General Hospital
- Samaritan Pacific Community Hospital
- Samaritan Lebanon Community Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal of nail tissue | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DO192939 | OR | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Corvallis Clinic P C | Current | Accepting new patients |
Locations
3600 NW Samaritan Dr
Ste 227
Corvallis, OR 97330
Phone (541) 768-1261
444 NW Elks Dr
Corvallis, OR 97330
Phone (541) 754-1256
3680 NW Samaritan Dr
Corvallis, OR 97330
Phone (541) 754-1282
Interoperability endpoints
- nicolette.rosendahl.1@14349.direct.athenahealth.com
- https://api.platform.athenahealth.com/14349/brand/4/csg/42/fhir/r4
Organizations & group practices 1
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.
-
- Multi-Specialty Clinic/Center
- Corvallis, OR
- NPI 1649227265
Hospital & facility affiliations 68
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": "1470096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647388800000",
"number": "1689127045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "444 NW ELKS DR",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973303745",
"telephone_number": "541-754-1150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3680 NW SAMARITAN DR",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973303737",
"telephone_number": "541-754-1260"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSENDAHL",
"first_name": "NICOLETTE",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-02",
"last_updated": "2022-03-16",
"certification_date": "2022-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "204D00000X",
"taxonomy_group": "",
"desc": "Neuromusculoskeletal Medicine & OMM",
"state": "OR",
"license": "DO192939",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IA",
"license": "R10627",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OR",
"license": "DO192939",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"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 Mar 16, 2022; 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.