NPIMap

Organization Active NPI

Salem Clinic, PC

  • General Practice Physician
  • Keizer, OR
National Provider Identifier
1992973622
Registry record updated Dec 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
SALEM CLINIC, PC
Practice address
5900 Inland Shores Way N
Keizer, OR 97303-3795
Phone
(503) 399-2424
NPI assigned
Feb 15, 2008
Last updated
Dec 6, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2016

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

Authorized official

Name
Ms. Barbara Gunder
Title
Administrator/Cao
Phone
(503) 399-2470

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

5900 Inland Shores Way N
Keizer, OR 97303-3795

Mailing address

PO Box 8100
Salem, OR 97303-0900
Phone (503) 399-2424

Other identifiers 3

IdentifierTypeStateIssuer
CS4159OtherORRAILROAD MEDICARE NO.
500400276MedicaidOR
R0000WCJWKOtherORMEDICARE PTAN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D0938355Salem Clinic Inland Shores5900 Inland Shores Way N, Keizer, OR 97303Certificate of waiverJan 1, 2027

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

2531 Boone Rd SE
Salem, OR 97306
Phone (503) 399-2470

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1203033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480982400000",
    "number": "1992973622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8100",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973030900",
            "telephone_number": "503-399-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 INLAND SHORES WAY N",
            "city": "KEIZER",
            "state": "OR",
            "postal_code": "973033795",
            "telephone_number": "503-399-2424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALEM CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-15",
        "last_updated": "2016-12-06",
        "status": "A",
        "authorized_official_last_name": "GUNDER",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "ADMINISTRATOR/CAO",
        "authorized_official_telephone_number": "503-399-2470",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE NO.",
            "identifier": "CS4159",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500400276",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "R0000WCJWK",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Keizer, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.