NPIMap

Individual provider Active NPI

Crystal Marie Rodriguez, PA-C

  • Physician Assistant
  • Corvallis, OR
National Provider Identifier
1780136242
Registry record updated Mar 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
5234 SW Philomath Blvd
Corvallis, OR 97333-1042
Phone
(541) 768-4970
NPI assigned
Nov 1, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

5234 SW Philomath Blvd
Corvallis, OR 97333-1042

Mailing address

PO Box 1189
Corvallis, OR 97339-1189

Other practice location 1

5050 NE Hoyt St
Suite 240
Portland, OR 97213-2991
Phone (503) 215-6469

Other names 1

  • Crystal Marie Gleisner Former name

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address crodriguez775148@oc.providencedirect.org
Direct Messaging Address crodriguez775148@oc.providencedirect.org
Direct Messaging Address crodriguez260705@samhealth.direct-ci.com

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
I20170103001432 OR Practitioner - Physician Assistant 4789965849 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
George Washington University School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Good Samaritan Hospital CorvallisGroup PAC ID 1557270725, 372 clinicians
Mid-Valley Healthcare IncGroup PAC ID 2769391523, 143 clinicians

Practice addresses (Care Compare)

3600 NW Samaritan Dr
Corvallis, OR 97330-3737

400 N Santiam Hwy
Lebanon, OR 97355
Phone (541) 451-6388

5234 SW Philomath Blvd
Corvallis, OR 97333-1042
Phone (541) 768-4970

646 Holley Rd
Sweet Home, OR 97386-3344
Phone (541) 451-6272

679 Main St
Sweet Home, OR 97386-3305
Phone (541) 451-6250

990 NW Circle Blvd
Corvallis, OR 97330-1967

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.14 of 100Reported as group
Quality
85.78
Promoting interoperability
100
Improvement activities
40
Cost
78.31

Merit-based Incentive Payment System (MIPS)

Final score
94.37 of 100Reported as group
Quality
92.31
Promoting interoperability
100
Improvement activities
40
Cost
80.9

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-Valley Healthcare, Inc. CurrentSince Mar 6, 2023 Accepting new patients
Albany General Hospital CurrentSince Mar 6, 2023 Accepting new patients
Samaritan Pacific Health Services Inc CurrentSince Jul 15, 2023 Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Mar 6, 2023 Accepting new patients
Samaritan Pacific Health Services, Inc CurrentSince Jul 15, 2023 Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Mar 6, 2023 Accepting new patients
Albany General Hospital CurrentSince Mar 6, 2023 Accepting new patients
Mid-Valley Healthcare Inc CurrentSince Mar 6, 2023 Accepting new patients

Locations

705 Elm St SW
Ste 200
Albany, OR 97321
Phone (541) 812-4850

3600 NW Samaritan Dr
Ste 227
Corvallis, OR 97330
Phone (541) 768-1261

3600 NW Samaritan Dr
Corvallis, OR 97330
Phone (541) 768-4906

5234 SW Philomath Blvd
Corvallis, OR 97333
Phone (541) 768-4970

325 Park St
Lebanon, OR 97355
Phone (541) 451-7200

930 SW Abbey St
Newport, OR 97365
Phone (541) 265-2244

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 36

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

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1477958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679011200000",
    "number": "1780136242",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5234 SW PHILOMATH BLVD",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973331042",
            "telephone_number": "541-768-4970"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5050 NE Hoyt St",
            "address_2": "Suite 240",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972132991",
            "country_code": "US",
            "telephone_number": "503-215-6469",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "CRYSTAL",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-01",
        "last_updated": "2023-03-17",
        "certification_date": "2023-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "crodriguez775148@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "5050 NE Hoyt St",
            "address_2": "Suite 240",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972132991",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "crodriguez775148@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1321 NE 99th Ave Ste 100",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972209437",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "crodriguez260705@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "5234 SW Philomath Blvd",
            "city": "Corvallis",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973331042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CRYSTAL",
            "last_name": "GLEISNER",
            "middle_name": "MARIE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Corvallis, OR

Sources for this page

Verify at the official NPI Registry.