NPIMap

Individual provider Active NPI

Lance Gregory Loberg, MD

  • Family Medicine Physician
  • Grand Ronde, OR
National Provider Identifier
1932180734
Registry record updated Jun 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD13309 Issued in OR
Practice address
9605 Grand Ronde Rd
Grand Ronde, OR 97347-9712
Phone
(503) 879-2002
NPI assigned
Nov 8, 2005
Last updated
Jun 7, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD13309 OR Primary

Addresses

Primary practice location

9605 Grand Ronde Rd
Grand Ronde, OR 97347-9712

Mailing address

1002 Bellevue St SE
Salem, OR 97301-4006
Phone (503) 561-5554

Other identifiers 2

IdentifierTypeStateIssuer
023015MedicaidOR
267195MedicaidOR

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
I20080603000856 OR Practitioner - Family Practice 5799855649 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Washington School of Medicine, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

9615 Grand Ronde Rd
Grand Ronde, OR 97347-9712
Phone (503) 879-2007

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD13309ORMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Confederated Tribes of the Grand Ronde Community of Oregon Family Medicine CurrentSince Jul 21, 2014 Accepting new patients
Confederated Tribes of the Grand Ronde Community of Oregon CurrentSince Jul 21, 2014 Accepting new patients
Confederated Tribes of Grand Ronde Community of Oregon Dba GR Health & Past Accepting new patients

Locations

9605 Grand Ronde Rd
Grand Ronde, OR 97347
Phone (503) 879-2002

9615 Grand Ronde Rd
Grand Ronde, OR 97347
Phone (503) 879-2002

Interoperability endpoints

  • Direct secure messaging: lance.loberg.p1@direct.grandronde.nextgenshare.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623024000000",
    "number": "1932180734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 BELLEVUE ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973014006",
            "telephone_number": "503-561-5554",
            "fax_number": "503-561-4824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9605 GRAND RONDE RD",
            "city": "GRAND RONDE",
            "state": "OR",
            "postal_code": "973479712",
            "telephone_number": "503-879-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOBERG",
        "first_name": "LANCE",
        "middle_name": "GREGORY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-08",
        "last_updated": "2021-06-07",
        "certification_date": "2021-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD13309",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023015",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "267195",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Ronde, OR

Sources for this page

Verify at the official NPI Registry.