NPIMap

Individual provider Active NPI

Kyle M Van de Graaff, M.D.

  • Dermatology Physician
  • Corvallis, OR
National Provider Identifier
1770577025
Registry record updated Aug 31, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MD152734 Issued in OR
Practice address
444 NW Elks Dr
Corvallis, OR 97330-3745
Phone
(541) 754-1252
Fax
(541) 754-2772
NPI assigned
Sep 1, 2005
Last updated
Aug 31, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X MD152734 OR Primary

Addresses

Primary practice location

444 NW Elks Dr
Corvallis, OR 97330-3745

Mailing address

444 NW Elks Dr
Corvallis, OR 97330-3745
Phone (541) 754-1252

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101118000499 OR Practitioner - Dermatology 6204927684 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Texas Medical School at San Antonio, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Corvallis Clinic P CGroup PAC ID 1456244540, 128 clinicians

Practice addresses (Care Compare)

3680 NW Samaritan Dr
Corvallis, OR 97330-3737
Phone (541) 754-1150

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.16 of 100Reported as group
Quality
84.81
Promoting interoperability
100
Improvement activities
40
Cost
75.71

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision84
Removal of skin lesions632
Skin biopsy115

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Corvallis Clinic P C CurrentSince Nov 1, 2010 Accepting new patients

Locations

3680 NW Samaritan Dr
Corvallis, OR 97330
Phone (541) 754-1282

444 NW Elks Dr
Corvallis, OR 97330
Phone (541) 754-1256

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14349/brand/4/csg/42/fhir/r4
  • Direct secure messaging: kyle.van.de.graaff.1@14349.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1125532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283212800000",
    "number": "1770577025",
    "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": "541-754-1252",
            "fax_number": "541-754-2772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 NW ELKS DR",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303745",
            "telephone_number": "541-754-1252",
            "fax_number": "541-754-2772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DE GRAAFF",
        "first_name": "KYLE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-01",
        "last_updated": "2010-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OR",
            "license": "MD152734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corvallis, OR

Sources for this page

Verify at the official NPI Registry.