NPIMap

Organization Active NPI

Good Samaritan Hospital Corvallis

Doing business as Samaritan Obstetrics, Gynecology & Midwifery

  • Obstetrics & Gynecology Physician
  • Corvallis, OR
National Provider Identifier
1871859017
Registry record updated Apr 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
GOOD SAMARITAN HOSPITAL CORVALLIS
Doing business as
Samaritan Obstetrics, Gynecology & Midwifery
Practice address
3640 NW Samaritan Dr Ste 220
Corvallis, OR 97330-3784
Phone
(541) 768-5300
NPI assigned
Apr 2, 2012
Last updated
Apr 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2024

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

Authorized official

Name
Laura Hennum
Title
Ceo
Phone
(541) 768-5001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X NU Primary

Addresses

Primary practice location

3640 NW Samaritan Dr Ste 220
Corvallis, OR 97330-3784

Mailing address

3640 NW Samaritan Dr Ste 220
Corvallis, OR 97330-3738
Phone (541) 768-5300

Other identifiers 1

IdentifierTypeStateIssuer
500651472MedicaidOR

Other names 1

  • Samaritan Obstetrics, Gynecology & Midwifery Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031125000163 OR Part B Supplier - Clinic/Group Practice 1557270725 Receives reassigned benefits from 589 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Corvallis, OR; Albany, OR

National Provider Directory

National Provider Directory
Tax ID family
Wayne Phillips50 organizations share this tax ID, including this one

Other organizations with this tax ID 49

Organizations that report the same tax identification number in the National Provider Directory.

View all 49

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1333324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713830400000",
    "number": "1871859017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3640 NW SAMARITAN DR STE 220",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303738",
            "telephone_number": "541-768-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3640 NW SAMARITAN DR STE 220",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303784",
            "telephone_number": "541-768-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN HOSPITAL CORVALLIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-02",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A",
        "authorized_official_last_name": "HENNUM",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-768-5001"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500651472",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Samaritan Obstetrics, Gynecology & Midwifery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Apr 23, 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.

Verify at the official NPI Registry.