NPIMap

Santiam Memorial Hospital

Organization Active NPI Podiatric Clinic/Center · Stayton, OR

NPI 1912413147 · NPPES record last updated Aug 15, 2019

Key facts

NPI
1912413147
Entity type
Organization (NPI type 2)
Primary specialty
Podiatric Clinic/Center 261QP1100X
Legal business name
SANTIAM MEMORIAL HOSPITAL
Practice address
1369 N 10TH Ave
Stayton, OR 97383
Phone
(503) 769-7960
Fax
(503) 769-2172
NPI assigned
Dec 26, 2017
Organization subpart
No

Authorized official

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

Other NPIs on the same Medicare enrollment 22

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

Corporate family (same tax ID) 16

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

Practitioners 17

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in OR

Medicare enrollment records

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

National Provider Directory

Tax ID family
Santaim Memorial Hospit (17 organizations share this tax ID)

Specialties & licenses

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

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

  • Santiam Podiatry Clinic Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 15, 2019.

{
    "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

All providers in Stayton, OR · Podiatric Clinic/Center in Oregon

Sources for this page

Verify at the official NPI Registry.