Organization Active NPI

Corvallis Radiology PC

  • Diagnostic Radiology Physician
  • Corvallis, OR
National Provider Identifier
1881651289
Registry record updated Oct 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
18144 Issued in OR
Legal business name
CORVALLIS RADIOLOGY PC
Practice address
777 NW 9TH St Ste 210C
Corvallis, OR 97330-6169
Phone
(541) 452-8002
Fax
(541) 758-3713
NPI assigned
Apr 28, 2006
Last updated
Oct 16, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2026

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

Authorized official

Name
Mr. Leila BenderNPI 1619061165
Title
Managing Member
Phone
(541) 452-8002

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 18144 OR Primary

Addresses

Primary practice location

777 NW 9TH St Ste 210C
Corvallis, OR 97330-6169

Mailing address

PO Box 745249
Los Angeles, CA 90074-5249
Phone (800) 475-3698

Other practice location 1

3600 NW Samaritan Dr
Corvallis, OR 97330-3737
Phone (800) 475-3698

Other identifiers 1

IdentifierTypeStateIssuer
142612MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://cpiapigateway.cms.gov/api/esmdf/ext/v1/fhir/Practitioner/ Other Management Services Network, LLC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA, CA, MT, AZ, CO, FL, KS, MI, WI, TX, HI, GA, ID, PA, MD, VA, MA, NV, SC, UT, NY22 enrollments

Enrollment records 22

Enrollment IDStateProvider typePAC IDDetails
O20040305000892 OR Part B Supplier - Clinic/Group Practice 2062300676 Receives reassigned benefits from 25 practitioners
Practice locations: Corvallis, OR; La Grande, OR; Lebanon, OR; Lincoln City, OR; McMinnville, OR; Newport, OR; Salem, OR; Adair Village, OR…
O20070320000216 WA Part B Supplier - Clinic/Group Practice 2062300676 Receives reassigned benefits from 4 practitioners
Practice locations: Anacortes, WA; Bellevue, WA; Seattle, WA; Spokane, WA
O20150727000428 CA Part B Supplier - Clinic/Group Practice 2062300676 Receives reassigned benefits from 4 practitioners
Practice locations: Huntington Beach, CA; Napa, CA; Rancho Cucamonga, CA; San Diego, CA
O20220211001805 MT Part B Supplier - Clinic/Group Practice 2062300676 Receives reassigned benefits from 1 practitioner
Practice locations: Kalispell, MT; Whitefish, MT
O20240909002467 AZ Part B Supplier - Clinic/Group Practice 2062300676 Receives reassigned benefits from 2 practitioners
Practice locations: Paradise Valley, AZ; Scottsdale, AZ
O20250627003056 CO Part B Supplier - Clinic/Group Practice 2062300676 Receives reassigned benefits from 5 practitioners
Practice locations: Colorado Springs, CO; Denver, CO; Grand Junction, CO; Parker, CO
O20250701000691 FL Part B Supplier - Clinic/Group Practice 2062300676 Receives reassigned benefits from 7 practitioners
Practice locations: Beverly Hills, FL; Highland Beach, FL; Melbourne Beach, FL; North Miami Beach, FL; Palm City, FL; Sarasota, FL; Wellington, FL
O20250725000806 KS Part B Supplier - Clinic/Group Practice 2062300676 Receives reassigned benefits from 2 practitioners
Practice locations: Topeka, KS; Hays, KS
O20250726000043 MI Part B Supplier - Clinic/Group Practice 2062300676 Receives reassigned benefits from 1 practitioner
Practice locations: West Bloomfield, MI
O20250730001584 WI Part B Supplier - Clinic/Group Practice 2062300676 Receives reassigned benefits from 1 practitioner
Practice locations: Beloit, WI
O20250730004583 TX Part B Supplier - Clinic/Group Practice 2062300676 Receives reassigned benefits from 3 practitioners
Practice locations: Dripping Springs, TX; Spicewood, TX; Houston, TX
O20250731002634 HI Part B Supplier - Clinic/Group Practice 2062300676 Receives reassigned benefits from 1 practitioner
Practice locations: Honolulu, HI
O20250731002958 GA Part B Supplier - Clinic/Group Practice 2062300676 Receives reassigned benefits from 2 practitioners
Practice locations: Macon, GA; Clayton, GA
O20250731003021 ID Part B Supplier - Clinic/Group Practice 2062300676 Receives reassigned benefits from 2 practitioners
Practice locations: Coeur D Alene, ID; Worley, ID
O20250804004004 PA Part B Supplier - Clinic/Group Practice 2062300676 Receives reassigned benefits from 1 practitioner
Practice locations: Venetia, PA
O20250811000358 MD Part B Supplier - Clinic/Group Practice 2062300676 Receives reassigned benefits from 1 practitioner
Practice locations: Clarksville, MD
O20250813004094 VA Part B Supplier - Clinic/Group Practice 2062300676 Receives reassigned benefits from 2 practitioners
Practice locations: Glen Allen, VA; Leesburg, VA
O20250815001285 MA Part B Supplier - Clinic/Group Practice 2062300676 Receives reassigned benefits from 2 practitioners
Practice locations: Boxford, MA; Lexington, MA
O20250826003362 NV Part B Supplier - Clinic/Group Practice 2062300676 Receives reassigned benefits from 1 practitioner
Practice locations: Reno, NV
O20250906000882 SC Part B Supplier - Clinic/Group Practice 2062300676 Receives reassigned benefits from 1 practitioner
Practice locations: Sullivans Island, SC
O20251217003375 UT Part B Supplier - Clinic/Group Practice 2062300676 Receives reassigned benefits from 2 practitioners
Practice locations: St George, UT; Washington, UT
O20260511002103 NY Part B Supplier - Clinic/Group Practice 2062300676 Receives reassigned benefits from 1 practitioner
Practice locations: Sag Harbor, NY

National Provider Directory

National Provider Directory

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

1700 Geary St SE
Ste 400
Albany, OR 97322
Phone (541) 812-5500

400 Hickory St NW
Albany, OR 97321
Phone (541) 812-4135

3615 NW Samaritan Dr
Ste 101
Corvallis, OR 97330
Phone (541) 757-5187

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

777 NW 9th St
Ste 210C
Corvallis, OR 97330
Phone (541) 452-8002

938 NW Kings Blvd
Corvallis, OR 97330
Phone (541) 758-5407

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

505 N Santiam Hwy
Lebanon, OR 97355
Phone (541) 451-6950

2811 E Madison St
Ste 202
Seattle, WA 98112

Practitioners & affiliated clinicians

Practitioners 74

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 74

NPI Registry JSON

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792108800000",
    "number": "1881651289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 745249",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900745249",
            "telephone_number": "800-475-3698",
            "fax_number": "541-758-3713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 NW 9TH ST STE 210C",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973306169",
            "telephone_number": "541-452-8002",
            "fax_number": "541-758-3713"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3600 NW Samaritan Dr",
            "address_purpose": "LOCATION",
            "city": "Corvallis",
            "state": "OR",
            "postal_code": "973303737",
            "country_code": "US",
            "telephone_number": "800-475-3698",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CORVALLIS RADIOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-28",
        "last_updated": "2026-10-16",
        "certification_date": "2026-10-16",
        "status": "A",
        "authorized_official_last_name": "BENDER",
        "authorized_official_first_name": "LEILA",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "541-452-8002",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OR",
            "license": "18144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142612",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://cpiapigateway.cms.gov/api/esmdf/ext/v1/fhir/Practitioner/",
            "affiliation": "Y",
            "endpointDescription": "urn:oid:2.16.840.1.113883.3.1036.1",
            "affiliationName": "Management Services Network, LLC",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2357 Warm Springs Rd Ste 400",
            "city": "Columbus",
            "state": "GA",
            "country_code": "US",
            "postal_code": "319046874",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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 Oct 16, 2026; 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.