NPIMap

Organization Active NPI

Albany General Hospital

Doing business as Albany Internal Medicine Resident Clinic

  • Internal Medicine Physician
  • Albany, OR
National Provider Identifier
1780090019
Registry record updated Jul 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
14-1459 Issued in OR
Legal business name
ALBANY GENERAL HOSPITAL
Doing business as
Albany Internal Medicine Resident Clinic
Practice address
1086 7TH Ave SW
Suite 101
Albany, OR 97321-1997
Phone
(541) 812-3349
Fax
(541) 812-2942
NPI assigned
Jul 8, 2014
Last updated
Jul 8, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2014

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

Authorized official

Name
Mr. David G. Triebes, MBA
Title
Ceo
Phone
(541) 812-4102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 14-1459 OR Primary

Addresses

Primary practice location

1086 7TH Ave SW
Suite 101
Albany, OR 97321-1997

Mailing address

1086 7TH Ave SW
Suite 101
Albany, OR 97321-1997
Phone (541) 812-3349

Other names 1

  • Albany Internal Medicine Resident Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040310000310 OR Part B Supplier - Clinic/Group Practice 9931097987 Receives reassigned benefits from 473 practitioners
31 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Albany, OR
O20050214000492 OR Part A Provider - Hospital 9931097987 16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Albany, OR; Corvallis, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780090019. Details of each certification follow.

Hospital certification: CCN 380022

Legal name
ALBANY GENERAL HOSPITAL
Doing business as
SAMARITAN ALBANY GENERAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jan 7, 2010
Beds
79
Ownership / control type
Church
Most recent change of ownership
Jan 1, 2000 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Oct 12, 1925 in OR
Enrollment address
1046 6TH Ave SW
Albany, OR 97321-1916
Main/Primary Hospital Location
Hospital subgroups
General

Other NPIs on the same Medicare enrollment 33

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

View all 33

Care Compare: Hospital

Medicare Care Compare
Listed as
Samaritan Albany General HospitalCCN 380022 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
John R Ward Individual Corporate DirectorBoard of Director Jan 1, 2018
Brian R Summers Individual Corporate Director Dec 1, 2019
Seth K Arrow Individual Corporate DirectorBoard Member Jan 1, 2024
Stacy Koos Individual Corporate OfficerVice Chair Jan 1, 2018
Corporate DirectorBoard of Director Jan 1, 2017
Samaritan Health Services Inc. Organization, Corvallis, OR Corporation Operational/Managerial Control Jan 1, 2000 100%
Kristal Dufour Individual Corporate DirectorBoard Member Jan 1, 2023
Daniel Keteri Individual Corporate OfficerCeo Jun 1, 2019
Operational/Managerial ControlCeo Jun 1, 2019
Scott a Schindell Individual Corporate DirectorBoard Member Jan 1, 2025
Karsen O'Bryan Individual Corporate DirectorBoard Member Jan 1, 2025
Paul M Greaves Individual Corporate DirectorBoard Member Jan 1, 2023
April Grace Jensen Individual Corporate DirectorBoard Member Jan 1, 2023
Rick Kenyon Individual Corporate DirectorBoard of Director Jan 1, 2018
Stacie Lafollette Individual W-2 Managing EmployeeAccess Manager Jan 1, 2022
Daniel Burton Smith Individual Corporate OfficerVice President Finance/Cfo Jan 1, 2000
Operational/Managerial ControlSr. Vice President/Cfo Jan 1, 2000

Owners & managing parties with NPI records 6

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 4

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.

Affiliated clinicians 547

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 547

NPI Registry JSON

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

{
    "created_epoch": "1404777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404777600000",
    "number": "1780090019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1086 7TH AVE SW",
            "address_2": "SUITE 101",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973211997",
            "telephone_number": "541-812-3349",
            "fax_number": "541-812-2942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1086 7TH AVE SW",
            "address_2": "SUITE 101",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973211997",
            "telephone_number": "541-812-3349",
            "fax_number": "541-812-2942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBANY GENERAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-08",
        "last_updated": "2014-07-08",
        "status": "A",
        "authorized_official_last_name": "TRIEBES",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-812-4102",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "14-1459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Albany Internal Medicine Resident Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Albany, OR

Sources for this page

Verify at the official NPI Registry.