Active NPI
Santiam Mobile Medicine LLC
- Nurse Practitioner
- Stayton, OR
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- Legal business name
- SANTIAM MOBILE MEDICINE LLC
- Practice address
- 41805 Stayton Scio Rd SE
Stayton, OR 97383-9739 - Phone
- (503) 507-5356
- Fax
- (866) 225-2708
- NPI assigned
- Jan 20, 2018
- Last updated
- May 31, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Casey Lulay, MSN, FNP
- Title
- Member
- Phone
- (503) 507-5356
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | Primary |
Addresses
Primary practice location
41805 Stayton Scio Rd SE
Stayton, OR 97383-9739
Mailing address
PO Box 118
Stayton, OR 97383-0118
Phone (503) 507-5356
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500673258 | Medicaid | OR | |
| 500779652 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 38D2146974 | Santiam Mobile Medicine | Certificate of waiver | Apr 9, 2028 |
National Provider Directory
National Provider DirectoryLocations
41805 Stayton Scio Rd SE
Stayton, OR 97383
Phone (503) 507-5356
Interoperability endpoints
- https://api.platform.athenahealth.com/19033/brand/1/csg/1/fhir/r4
Practitioners & affiliated clinicians
Practitioners 7
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.
-
- Nurse Practitioner
- Stayton, OR
- NPI 1295151686
-
- Family Nurse Practitioner
- Stayton, OR
- NPI 1578981379
-
- Family Nurse Practitioner
- Stayton, OR
- NPI 1265307268
Single Specialty
-
- Family Nurse Practitioner
- Lebanon, OR
- NPI 1174227078
-
- Family Nurse Practitioner
- Stayton, OR
- NPI 1285090779
-
- Family Nurse Practitioner
- Stayton, OR
- NPI 1083091029
-
- Psychiatry Physician
- Glendale, AZ
- NPI 1558715490
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516406400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1748649600000",
"number": "1750899035",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 118",
"city": "STAYTON",
"state": "OR",
"postal_code": "973830118",
"telephone_number": "503-507-5356",
"fax_number": "866-225-1708"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41805 STAYTON SCIO RD SE",
"city": "STAYTON",
"state": "OR",
"postal_code": "973839739",
"telephone_number": "503-507-5356",
"fax_number": "866-225-2708"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SANTIAM MOBILE MEDICINE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-01-20",
"last_updated": "2025-05-31",
"certification_date": "2025-05-31",
"status": "A",
"authorized_official_last_name": "LULAY",
"authorized_official_first_name": "CASEY",
"authorized_official_title_or_position": "MEMBER",
"authorized_official_telephone_number": "503-507-5356",
"authorized_official_credential": "MSN, FNP"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500673258",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500779652",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Stayton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.