NPIMap

Individual provider Active NPI

Riley Hackley, PA-C

  • Physician Assistant
  • Lebanon, OR
National Provider Identifier
1922825009
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA222009 Issued in OR
Practice address
425 N Santiam Hwy
Lebanon, OR 97355-4361
Phone
(541) 451-6960
NPI assigned
Sep 20, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X PA222009 OR
Physician Assistant 363A00000X PA222009 OR Primary

Addresses

Primary practice location

425 N Santiam Hwy
Lebanon, OR 97355-4361

Mailing address

PO Box 1189
Corvallis, OR 97339-1189

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rhackley159759@samhealth.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241024003151 OR Practitioner - Physician Assistant 5991238289 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mid-Valley Healthcare IncGroup PAC ID 2769391523, 143 clinicians

Practice addresses (Care Compare)

425 N Santiam Hwy
Lebanon, OR 97355-4361

Hospital & facility affiliations

  • Samaritan Lebanon Community Hospital Hospital, Lebanon, OR, CCN 381323
  • Good Samaritan Regional Medical Center Hospital, Corvallis, OR, CCN 380014

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-Valley Healthcare Inc Single Specialty CurrentSince Nov 1, 2024 Accepting new patients
Samaritan Pacific Health Services Inc Single Specialty CurrentSince Jan 24, 2026 Accepting new patients
Samaritan Pacific Health Services, Inc CurrentSince Jan 24, 2026 Accepting new patients
Mid-Valley Healthcare, Inc. CurrentSince Jan 24, 2026 Accepting new patients
Samaritan Pacific Health Services, Inc. CurrentSince Jan 24, 2026 Accepting new patients
Samaritan North Lincoln Hospital CurrentSince Jan 24, 2026 Accepting new patients
Samaritan North Lincoln Hospital CurrentSince Jan 24, 2026 Accepting new patients
Mid-Valley Healthcare, Inc. CurrentSince Nov 1, 2024 Accepting new patients

Locations

815 NW 9th St
Ste 215
Corvallis, OR 97330
Phone (541) 768-1888

425 N Santiam Hwy
Lebanon, OR 97355
Phone (541) 451-6960

325 Park St
Lebanon, OR 97355
Phone (541) 451-7200

Interoperability endpoints

  • Direct secure messaging: rhackley159759@samhealth.direct-ci.com

Organizations & group practices 12

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.

Hospital & facility affiliations 36

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1726790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732492800000",
    "number": "1922825009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1189",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 N SANTIAM HWY",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973554361",
            "telephone_number": "541-451-6960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKLEY",
        "first_name": "RILEY",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-20",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "PA222009",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA222009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rhackley159759@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "425 N Santiam Hwy",
            "city": "Lebanon",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973554361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lebanon, OR

Sources for this page

Verify at the official NPI Registry.