NPIMap

Organization Active NPI

Santiam Memorial Hospital

Doing business as Santiam Podiatry Clinic

  • Podiatric Clinic/Center
  • Stayton, OR
National Provider Identifier
1912413147
Registry record updated Aug 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Podiatric Clinic/CenterTaxonomy code 261QP1100X
Legal business name
SANTIAM MEMORIAL HOSPITAL
Doing business as
Santiam Podiatry Clinic
Practice address
1369 N 10TH Ave
Stayton, OR 97383
Phone
(503) 769-7960
Fax
(503) 769-2172
NPI assigned
Dec 26, 2017
Last updated
Aug 15, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2019

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

Authorized official

Name
Lynda Fraser
Title
Clinic Director
Phone
(503) 769-9254

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatric Clinic/Center 261QP1100X Primary

Addresses

Primary practice location

1369 N 10TH Ave
Stayton, OR 97383

Mailing address

1369 N 10TH Ave
Stayton, OR 97383-2037
Phone (503) 769-7960

Other practice location 1

404 Welch St
Silverton, OR 97381
Phone (503) 769-7960

Other names 1

  • Santiam Podiatry Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040130000239 OR Part B Supplier - Clinic/Group Practice 6103729751 Receives reassigned benefits from 154 practitioners
22 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mill City, OR; Aumsville, OR; Sublimity, OR; Stayton, OR

Other NPIs on the same Medicare enrollment 22

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 22

National Provider Directory

National Provider Directory
Tax ID family
Scott Boren17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1514246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565827200000",
    "number": "1912413147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1369 N 10TH AVE",
            "city": "STAYTON",
            "state": "OR",
            "postal_code": "973832037",
            "telephone_number": "503-769-7960",
            "fax_number": "503-769-2172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1369 N 10TH AVE",
            "city": "STAYTON",
            "state": "OR",
            "postal_code": "97383",
            "telephone_number": "503-769-7960",
            "fax_number": "503-769-2172"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "404 Welch St",
            "address_purpose": "LOCATION",
            "city": "Silverton",
            "state": "OR",
            "postal_code": "97381",
            "country_code": "US",
            "telephone_number": "503-769-7960",
            "fax_number": "503-769-2172",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SANTIAM MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-26",
        "last_updated": "2019-08-15",
        "status": "A",
        "authorized_official_last_name": "FRASER",
        "authorized_official_first_name": "LYNDA",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "503-769-9254"
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Santiam Podiatry Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stayton, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2019; 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.