WVP Medical Group, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WVP MEDICAL GROUP, LLC

Practice address

5050 Skyline Village Loop S
Salem, OR 97306-9490

Phone

(503) 391-1110

Fax

(503) 370-4237

NPI assigned

Dec 13, 2016

Organization subpart

Yes

Parent organization

MID VALLEY IPA, INCAs reported in NPPES

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

Authorized official

Name

Mr. Dean Andretta

Title

Cfo

Phone

(503) 371-7701

Specialties & licenses 5

Addresses

Other identifiers 1

Other names 1

• WVP The Doctors Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Other NPIs on the same Medicare enrollment 8

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

• WVP Medical Group, LLC

  • Primary Care Clinic/Center
  • Salem, OR
  • NPI 1124352877

  O20100209000818

  Same enrollment
• WVP Medical Group, LLC

  • Primary Care Clinic/Center
  • Dallas, OR
  • NPI 1164780060

  O20100209000818

  Same enrollment
• WVP Medical Group, LLC

  • Primary Care Clinic/Center
  • Salem, OR
  • NPI 1518225242

  O20100209000818

  Same enrollment
• WVP Medical Group, LLC

  • Clinic/Center
  • Independence, OR
  • NPI 1538535059

  O20100209000818

  Same enrollment
• WVP Medical Group, LLC

  • Family Medicine Physician
  • Salem, OR
  • NPI 1710231550

  O20100209000818

  Same enrollment
• WVP Medical Group, LLC

  • Primary Care Clinic/Center
  • Keizer, OR
  • NPI 1750684767

  O20100209000818

  Same enrollment
• WVP Medical Group, LLC

  • Clinic/Center
  • Salem, OR
  • NPI 1831504968

  O20100209000818

  Same enrollment
• WVP Medical Group, LLC

  • Community/Behavioral Health Agency
  • Salem, OR
  • NPI 1922583616

  O20100209000818

  Same enrollment

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

{
    "created_epoch": "1481587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523923200000",
    "number": "1982148789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2995 RYAN DR SE STE 200",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973015157",
            "telephone_number": "503-371-7701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 SKYLINE VILLAGE LOOP S",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973069490",
            "telephone_number": "503-391-1110",
            "fax_number": "503-370-4237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WVP MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MID VALLEY IPA, INC",
        "enumeration_date": "2016-12-13",
        "last_updated": "2018-04-17",
        "status": "A",
        "authorized_official_last_name": "ANDRETTA",
        "authorized_official_first_name": "DEAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "503-371-7701",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "288533",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WVP The Doctors Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• WVP Medical Group, LLC
• WVP Medical Group, LLC
• WVP Medical Group, LLC
• WVP Medical Group, LLC
• WVP Medical Group, LLC
• Kimberly Wyatt, MSW
• Jay M Wylam, DMD
• Michael L Wynn I, D.O.
• Xin Xiang, RN
• Rebecca Beaudry Xiong, DPT

• Family Medicine Physician in Salem, OR
• Providers in Salem, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2018; 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.