Active NPI
Shelly R Svoboda, M.D.
- Neurology Physician
- Corvallis, OR
National Provider Identifier
1891790952
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- MD152419
- Practice address
- 444 NW Elks Dr
Corvallis, OR 97330-3745 - Phone
- (541) 754-1150
- NPI assigned
- Jun 16, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 41101 | MN | |
| Neurology Physician | 2084N0400X | MD152419 | OR | Primary |
Addresses
Primary practice location
444 NW Elks Dr
Corvallis, OR 97330-3745
Mailing address
444 NW Elks Dr
Corvallis, OR 97330-3745
Phone (541) 754-1150
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 145421800 | Medicaid | MN | |
| 500625065 | Medicaid | OR | |
| P00958597 | Other | OR | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Noran Neurological Clinic P.a. | Past | Accepting new patients | |
| Quest Diagnostics LLC Il | Past | Accepting new patients |
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.
-
- Specialist
- Bloomington, MN
- NPI 1710098306
-
- Clinical Medical Laboratory
- Chicago, IL
- NPI 1669298055
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319587200000",
"number": "1891790952",
"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": "444 NW ELKS DR",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973303745",
"telephone_number": "541-754-1150"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SVOBODA",
"first_name": "SHELLY",
"middle_name": "R",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-06-16",
"last_updated": "2011-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MN",
"license": "41101",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "OR",
"license": "MD152419",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "145421800",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500625065",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00958597",
"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 Oct 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.