NPIMap

Individual provider Active NPI

Charles G Petrunin II, M.D.

  • Hematology & Oncology Physician
  • Salem, OR
National Provider Identifier
1881788099
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
MD21956 Issued in OR
Practice address
875 Oak St SE
Suite 4030
Salem, OR 97301-3975
Phone
(503) 561-6444
Fax
(503) 561-6440
NPI assigned
Oct 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X MD21956 OR Primary

Addresses

Primary practice location

875 Oak St SE
Suite 4030
Salem, OR 97301-3975

Mailing address

875 Oak St SE
Suite 4030
Salem, OR 97301-3975
Phone (503) 561-6444

Other identifiers 2

IdentifierTypeStateIssuer
MD21956OtherOROREGON LICENSE
229284MedicaidOR

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
I20070719000415 OR Practitioner - Hematology/OncologyPractitioner - Internal Medicine 2466553581 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/OncologyAlso: Internal Medicine
Education
University of Nevada School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oregon Oncology Specialists LLPGroup PAC ID 3971576240, 41 clinicians

Practice addresses (Care Compare)

875 Oak St SE
Suite 4030
Salem, OR 97301-3984
Phone (503) 561-6444

Hospital & facility affiliations

  • Salem Hospital Hospital, Salem, OR, CCN 380051
  • Salem Health West Valley Hospital, Dallas, OR, CCN 381308
  • Samaritan North Lincoln Hospital Hospital, Lincoln City, OR, CCN 381302

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD21956ORMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oregon Oncology Specialists, LLP Hematology & Oncology CurrentSince Aug 1, 2001 Accepting new patients
Oregon Oncology Specialists, LLP Hematology & Oncology CurrentSince Aug 1, 2001 Accepting new patients

Locations

875 Oak St SE
Ste 4030
Salem, OR 97301

Interoperability endpoints

  • Direct secure messaging: charles.petrunin@hoos.ikm.direct-ci.com

Organizations & group practices 2

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 10

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

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1881788099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 OAK ST SE",
            "address_2": "SUITE 4030",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013975",
            "telephone_number": "503-561-6444",
            "fax_number": "503-561-6440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 OAK ST SE",
            "address_2": "SUITE 4030",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013975",
            "telephone_number": "503-561-6444",
            "fax_number": "503-561-6440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRUNIN",
        "first_name": "CHARLES",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "OR",
            "license": "MD21956",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON LICENSE",
            "identifier": "MD21956",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "229284",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.