Active NPI
Kyle Mindick, DO
- Family Medicine Physician
- Corvallis, OR
National Provider Identifier
1760222715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- PG220680
- Practice address
- 3600 NW Samaritan Dr
Corvallis, OR 97330-5472 - Phone
- (541) 768-4906
- NPI assigned
- May 28, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | PG220680 | OR | Primary |
Addresses
Primary practice location
3600 NW Samaritan Dr
Corvallis, OR 97330-5472
Mailing address
3600 NW Samaritan Dr
Corvallis, OR 97330-5472
Phone (541) 768-4906
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240624004421 | OR | Order and Referring Only - Family Practice | 5698218287 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Interoperability endpoints
- kmindick300298@samhealth.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716854400000",
"number": "1760222715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3600 NW SAMARITAN DR",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973305472",
"telephone_number": "541-768-4906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3600 NW SAMARITAN DR",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973305472",
"telephone_number": "541-768-4906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MINDICK",
"first_name": "KYLE",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-05-28",
"last_updated": "2024-05-28",
"certification_date": "2024-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "PG220680",
"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 May 28, 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.