NPIMap

Organization Active NPI

Wimahl Family Clinic, PC

  • Family Medicine Physician
  • Astoria, OR
National Provider Identifier
1861664781
Registry record updated Oct 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
24702 Issued in OR
Legal business name
WIMAHL FAMILY CLINIC, PC
Practice address
2120 Exchange St
Suite 209
Astoria, OR 97103-3365
Phone
(503) 338-2993
Fax
(503) 338-2996
NPI assigned
Apr 1, 2008
Last updated
Oct 6, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2022

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

Authorized official

Name
Corrina Smith
Title
Clinic Manager
Phone
(503) 338-2993

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 24702 OR Primary

Addresses

Primary practice location

2120 Exchange St
Suite 209
Astoria, OR 97103-3365

Mailing address

2120 Exchange St
Suite 209
Astoria, OR 97103-3365
Phone (503) 338-2993

Other identifiers 2

IdentifierTypeStateIssuer
275225MedicaidOR
8377632MedicaidWA

Other names 1

  • Wimahl Family Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080611000158 OR Part B Supplier - Clinic/Group Practice 6507937018 Receives reassigned benefits from 3 practitioners
Practice locations: Astoria, OR

National Provider Directory

National Provider Directory

Locations

2158 Exchange St
Ste 209
Astoria, OR 97103
Phone (503) 338-2993

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1207008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665014400000",
    "number": "1861664781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2120 EXCHANGE ST",
            "address_2": "SUITE 209",
            "city": "ASTORIA",
            "state": "OR",
            "postal_code": "971033365",
            "telephone_number": "503-338-2993",
            "fax_number": "503-338-2996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 EXCHANGE ST",
            "address_2": "SUITE 209",
            "city": "ASTORIA",
            "state": "OR",
            "postal_code": "971033365",
            "telephone_number": "503-338-2993",
            "fax_number": "503-338-2996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WIMAHL FAMILY CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-01",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "CORRINA",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "503-338-2993"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "24702",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "275225",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8377632",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wimahl Family Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Astoria, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2022; 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.

Verify at the official NPI Registry.