NPIMap

Individual provider Active NPI

Somnath Jagannath Prabhu, M.D.

  • Diagnostic Radiology Physician
  • Corvallis, OR
National Provider Identifier
1689825135
Registry record updated Jan 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD199646 Issued in OR
Practice address
938 NW Kings Blvd
Corvallis, OR 97330-2505
Phone
(541) 758-5047
Fax
(541) 758-3713
NPI assigned
Oct 2, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X ML60026972 WA
Diagnostic Radiology Physician 2085R0202X MD60479844 WA
Surgery Physician 208600000X ML60026972 WA
Diagnostic Radiology Physician 2085R0202X MD199646 OR Primary

Addresses

Primary practice location

938 NW Kings Blvd
Corvallis, OR 97330-2505

Mailing address

PO Box 1418
Corvallis, OR 97339-1418
Phone (805) 286-3826

Other practice location 1

930 SW Abbey St
Newport, OR 97365-4820
Phone (541) 265-2244

Other practice location 2

19020 33rd Ave W
Suite 210
Lynnwood, WA 98036-4746
Phone (425) 563-1500

Other identifiers 1

IdentifierTypeStateIssuer
2018572MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sprabhu196992@samhealth.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, ID, OR, PA, NY5 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 5

Enrollment IDStateProvider typePAC IDDetails
I20151001002665 WA Practitioner - Diagnostic Radiology 9032427588 Reassigns benefits to 4 organizations
I20160504002408 ID Practitioner - Diagnostic Radiology 9032427588 Reassigns benefits to 1 organization
I20200820003190 OR Practitioner - Diagnostic Radiology 9032427588 Reassigns benefits to 5 organizations
I20240305001038 PA Practitioner - Diagnostic Radiology 9032427588 Reassigns benefits to 1 organization
I20260602003135 NY Practitioner - Diagnostic Radiology 9032427588 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allegheny Clinic RadiologyGroup PAC ID 8426364738, 153 clinicians

Practice addresses (Care Compare)

320 E N Ave
Pittsburgh, PA 15212-4756
Phone (412) 359-2459

5412 SW Jardine Ave
Corvallis, OR 97333-2333
Phone (412) 330-5860

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD60479844WAMDDiagnostic Radiology Physician
ML60026972WAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Radia Imaging Center Holdings LLC Diagnostic Radiology CurrentSince Jan 1, 2019 Accepting new patients
Okanogan County Public Hospital Dist No 4 CurrentSince Aug 13, 2015 Accepting new patients
Medical Imaging Northwest - Good Samaritan Hospital Imaging Alliance CurrentSince Jan 9, 2023 Accepting new patients
Evergreen Radia LLC Diagnostic Radiology CurrentSince Sep 8, 2015 Accepting new patients
Medical Imaging Northwest - Good Samaritan Hospital Imaging Alliance CurrentSince Jan 9, 2023 Accepting new patients
Tra-Minw P S CurrentSince Jan 9, 2023 Accepting new patients
Okanogan County Public Hospital Dist No 4 Current Accepting new patients
Allegheny Clinic Radiology Diagnostic Radiology CurrentSince Jan 21, 2024 Accepting new patients
Swedish Radia Imaging Center at Edmonds LLC Diagnostic Radiology CurrentSince Sep 8, 2015 Accepting new patients
Union Avenue Open MRI LLC CurrentSince Jan 9, 2023 Accepting new patients
Public Hospital District No 4, King County Wa Past Accepting new patients

Locations

189 E Main St
Westfield, NY 14787
Phone (716) 326-4921

565 Coal Valley Rd
Jefferson Hls, PA 15025
Phone (412) 469-5308

320 E North Ave
Pittsburgh, PA 15212
Phone (412) 359-3131

21700 Highway 99
Edmonds, WA 98026
Phone (425) 640-4949

13020 Meridian Ave S
Everett, WA 98208
Phone (425) 357-3700

11521 NE 128th St
Ste 200
Kirkland, WA 98034
Phone (425) 952-6100

19020 33rd Ave W
Ste 210
Lynnwood, WA 98036
Phone 42556315001

1025 153rd St SE
Ste 200
Mill Creek, WA 98012
Phone (425) 338-4000

3417 Ensign Rd NE
Olympia, WA 98506
Phone (360) 493-4600

222 15th Ave SE
Puyallup, WA 98372

18100 NE Union Hill Rd
Redmond, WA 98052
Phone (425) 498-2020

500 17th Ave
Seattle, WA 98122
Phone (206) 320-2111

1229 Madison St
Ste 900
Seattle, WA 98104
Phone (206) 292-6233

203 S Western Ave
Tonasket, WA 98855
Phone (509) 486-2151

4816 NE Thurston Way
Ste A
Vancouver, WA 98662
Phone (360) 254-4914

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1222905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610928000000",
    "number": "1689825135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1418",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391418",
            "telephone_number": "805-286-3826",
            "fax_number": "805-221-6843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "938 NW KINGS BLVD",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973302505",
            "telephone_number": "541-758-5047",
            "fax_number": "541-758-3713"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "930 SW Abbey St",
            "address_purpose": "LOCATION",
            "city": "Newport",
            "state": "OR",
            "postal_code": "973654820",
            "country_code": "US",
            "telephone_number": "541-265-2244",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "19020 33rd Ave W",
            "address_2": "Suite 210",
            "address_purpose": "LOCATION",
            "city": "Lynnwood",
            "state": "WA",
            "postal_code": "980364746",
            "country_code": "US",
            "telephone_number": "425-563-1500",
            "fax_number": "425-563-1374",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRABHU",
        "first_name": "SOMNATH",
        "middle_name": "JAGANNATH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-02",
        "last_updated": "2021-01-18",
        "certification_date": "2021-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "ML60026972",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "MD60479844",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "ML60026972",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OR",
            "license": "MD199646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2018572",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sprabhu196992@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "930 SW Abbey St",
            "city": "Newport",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973654820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Corvallis, OR

Sources for this page

Verify at the official NPI Registry.