NPIMap

Organization Active NPI

Oregon Heart Center PC

  • Cardiovascular Disease Physician
  • Salem, OR
National Provider Identifier
1902138969
Registry record updated Jul 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
OREGON HEART CENTER PC
Practice address
610 Hawthorne Ave SE Ste 110
Salem, OR 97301
Phone
(503) 814-4440
Fax
(503) 814-4444
NPI assigned
Feb 2, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2018

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

Authorized official

Name
Kim Ludwick
Title
Administrator
Phone
(503) 561-7171

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

610 Hawthorne Ave SE Ste 110
Salem, OR 97301

Mailing address

PO Box 886
Salem, OR 97308-0886
Phone (503) 814-4440

Other practice location 1

665 Winter Street SE
Building B, Suite B0350
Salem, OR 97301-3975
Phone (503) 814-4440

Other identifiers 2

IdentifierTypeStateIssuer
500618815MedicaidOR
R152591OtherORMEDICARE

Other names 1

  • Salem Heart Center PC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100414000856 OR Part B Supplier - Clinic/Group Practice 1951438472 Receives reassigned benefits from 15 practitioners
Practice locations: Salem, OR

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2008355Oregon Heart Center PC610 Hawthorne Ave SE, Salem, OR 97301Certificate of waiverJun 8, 2028

National Provider Directory

National Provider Directory

Member organizations 1

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

Locations

1128 NE 2nd St
Ste 101
Corvallis, OR 97330
Phone (503) 814-4440

610 Hawthorne Ave SE
Ste 110
Salem, OR 97301
Phone (503) 561-7160

665 Winter St SE
Ste B0350
Salem, OR 97301
Phone (503) 814-4440

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1265068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531267200000",
    "number": "1902138969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 886",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973080886",
            "telephone_number": "503-814-4440",
            "fax_number": "503-814-4444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 HAWTHORNE AVE SE STE 110",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97301",
            "telephone_number": "503-814-4440",
            "fax_number": "503-814-4444"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "665 Winter Street SE",
            "address_2": "Building B, Suite B0350",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973013975",
            "country_code": "US",
            "telephone_number": "503-814-4440",
            "fax_number": "503-814-4444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OREGON HEART CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-02",
        "last_updated": "2018-07-11",
        "status": "A",
        "authorized_official_last_name": "LUDWICK",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "503-561-7171"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500618815",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "R152591",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Salem Heart Center PC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Salem Heart Center PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2018; 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.