NPIMap

Organization Active NPI

Good Samaritan Hospital Corvallis

Doing business as Samaritan Pharmacy - 30th Street

  • Community/Retail Pharmacy
  • Corvallis, OR
National Provider Identifier
1710673116
Registry record updated Jul 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
GOOD SAMARITAN HOSPITAL CORVALLIS
Doing business as
Samaritan Pharmacy - 30th Street
Practice address
845 SW 30TH St Ste 201
Corvallis, OR 97331-8629
Phone
(541) 768-7850
NPI assigned
Apr 18, 2023
Last updated
Jul 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2024

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

Authorized official

Name
Joseph M Cahill
Title
Ceo-Gsrmc
Phone
(541) 768-7914

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

845 SW 30TH St Ste 201
Corvallis, OR 97331-8629

Mailing address

PO Box 1189
Corvallis, OR 97339-1189
Phone (541) 768-4410

Other names 1

  • Samaritan Pharmacy - 30th Street Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160909000893 OR Part B Supplier - Mass Immunization (Roster Biller Only) 1557270725 1 other NPI on this enrollment
Practice locations: Corvallis, OR
O20180102000947 OR Part B Supplier - Pharmacy 1557270725 1 other NPI on this enrollment
Practice locations: Corvallis, OR

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Good Samaritan Hospital50 organizations share this tax ID, including this one

Other organizations with this tax ID 49

Organizations that report the same tax identification number in the National Provider Directory.

View all 49

Locations

845 SW 30th St
Ste 201
Corvallis, OR 97331
Phone (541) 768-6095

NPI Registry JSON

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

{
    "created_epoch": "1681776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722297600000",
    "number": "1710673116",
    "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",
            "telephone_number": "541-768-4410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 SW 30TH ST STE 201",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973318629",
            "telephone_number": "541-768-7850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN HOSPITAL CORVALLIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-18",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A",
        "authorized_official_last_name": "CAHILL",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO-GSRMC",
        "authorized_official_telephone_number": "541-768-7914"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Samaritan Pharmacy - 30th Street",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Samaritan Pharmacy - 30th Street",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 30, 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.