NPIMap

Individual provider Active NPI

Jill M Provaznik, MD

  • Infectious Disease Physician
  • Corvallis, OR
National Provider Identifier
1992185995
Registry record updated May 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
MD189615 Issued in OR
Practice address
3640 NW Samaritan Dr Ste 210
Corvallis, OR 97330-3787
Phone
(541) 768-5810
NPI assigned
Jun 4, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD189615 OR
Infectious Disease Physician 207RI0200X 11262304-1205 UT
Infectious Disease Physician 207RI0200X MD189615 OR Primary

Addresses

Primary practice location

3640 NW Samaritan Dr Ste 210
Corvallis, OR 97330-3787

Mailing address

PO Box 1189
Corvallis, OR 97339-1189

Other practice location 1

30 N 1900 E Rm 4B319
Salt Lake City, UT 84132-0002
Phone (801) 581-8812

Other practice location 2

9205 SW Barnes Rd
Portland, OR 97225-6603
Phone (503) 216-2906

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jprovaznik203151@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
I20190225001975 OR Practitioner - Internal Medicine 8123331576 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Arkansas College of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Good Samaritan Hospital CorvallisGroup PAC ID 1557270725, 372 clinicians

Practice addresses (Care Compare)

3600 NW Samaritan Dr
Corvallis, OR 97330-3737

3640 NW Samaritan Dr
Suite 210
Corvallis, OR 97330-3787
Phone (541) 768-5810

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.14 of 100Reported as group
Quality
85.78
Promoting interoperability
100
Improvement activities
40
Cost
78.31

Merit-based Incentive Payment System (MIPS)

Final score
93.65 of 100Reported as group
Quality
86.8
Promoting interoperability
100
Improvement activities
40
Cost
86.36

Merit-based Incentive Payment System (MIPS)

Final score
96.77 of 100Reported as group
Quality
88.09
Promoting interoperability
100
Improvement activities
40
Cost
84.48

Merit-based Incentive Payment System (MIPS)

Final score
86.57 of 100Reported as group
Quality
93.49
Promoting interoperability
100
Improvement activities
40
Cost
61.74

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD189615ORMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-Valley Healthcare Inc CurrentSince Aug 30, 2021 Accepting new patients
Samaritan Pacific Health Services, Inc. CurrentSince Aug 30, 2021 Accepting new patients
Samaritan Pacific Health Services, Inc CurrentSince Aug 30, 2021 Accepting new patients
Mid-Valley Healthcare, Inc. CurrentSince Aug 30, 2021 Accepting new patients
Mid-Valley Healthcare Inc Current Accepting new patients
Good Samaritan Hospital Corvallis Current Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Aug 30, 2021 Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Aug 30, 2021 Accepting new patients

Locations

3600 NW Samaritan Dr
Ste 227
Corvallis, OR 97330
Phone (541) 768-1261

3640 NW Samaritan Dr
Ste 210
Corvallis, OR 97330
Phone (541) 752-7721

3600 NW Samaritan Dr
Corvallis, OR 97330
Phone (541) 768-4906

777 NW 9th St
Ste 102
Corvallis, OR 97330
Phone (541) 768-6769

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

930 SW Abbey St
Newport, OR 97365
Phone (541) 265-2244

Interoperability endpoints

  • Direct secure messaging: jprovaznik203151@samhealth.direct-ci.com

Organizations & group practices 8

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 74

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

View all 74

NPI Registry JSON

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

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683849600000",
    "number": "1992185995",
    "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": "3640 NW SAMARITAN DR STE 210",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303787",
            "telephone_number": "541-768-5810"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "30 N 1900 E Rm 4B319",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841320002",
            "country_code": "US",
            "telephone_number": "801-581-8812",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9205 SW Barnes Rd",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972256603",
            "country_code": "US",
            "telephone_number": "503-216-2906",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROVAZNIK",
        "first_name": "JILL",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-04",
        "last_updated": "2023-05-12",
        "certification_date": "2023-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD189615",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "UT",
            "license": "11262304-1205",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "OR",
            "license": "MD189615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jprovaznik203151@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "3640 NW Samaritan Dr Ste 210",
            "city": "Corvallis",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973303787",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Corvallis, OR

Sources for this page

Verify at the official NPI Registry.