NPIMap

Organization Active NPI

The Corvallis Clinic P C

  • Ambulatory Surgical Clinic/Center
  • Corvallis, OR
National Provider Identifier
1881850386
Registry record updated Aug 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
THE CORVALLIS CLINIC P C
Practice address
601 NW Elks Drive
Corvallis, OR 97330-3781
Phone
(541) 754-1254
NPI assigned
Aug 4, 2008
Organization subpart
Yes
Parent organization
THE CORVALLIS CLINIC P CAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 23, 2024

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

Authorized official

Name
Mr. James Kaech
Title
Ceo
Phone
(541) 754-1374

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X OR Primary

Addresses

Primary practice location

601 NW Elks Drive
Corvallis, OR 97330-3781

Mailing address

444 NW Elks Dr
Corvallis, OR 97330-3745
Phone (541) 754-1150

Other identifiers 2

IdentifierTypeStateIssuer
500600864MedicaidOR
043158MedicaidOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070118000203 OR Part B Supplier - Ambulatory Surgical Center 1456244540 Practice locations: Corvallis, OR

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Corvallis Clinic PC Dba the Corvallis Clinic Surgery CenterCCN 38C0001081
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Yogi Investments LLC18 organizations share this tax ID, including this one
Part of
Yogi Investments LLC

Other organizations with this tax ID 17

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

View all 17

Practitioners & affiliated clinicians

Practitioners 128

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 128

NPI Registry JSON

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

{
    "created_epoch": "1217808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724371200000",
    "number": "1881850386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 NW ELKS DR",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303745",
            "telephone_number": "541-754-1150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 NW ELKS DRIVE",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303781",
            "telephone_number": "541-754-1254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CORVALLIS CLINIC P C",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE CORVALLIS CLINIC P C",
        "enumeration_date": "2008-08-04",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A",
        "authorized_official_last_name": "KAECH",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-754-1374",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500600864",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "043158",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "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 Aug 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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.