WVP MEDICAL GROUP, LLC (NPI# 1982148789) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982148789 |
| Entity Type | Organization |
| Organization Name | WVP MEDICAL GROUP, LLC |
| Other Organization Name | WVP THE DOCTORS CLINIC |
| Practice Address |
5050 Skyline Village Loop S Salem OR 97306-9490 |
| Mailing Address |
2995 Ryan Dr Se Ste 200 Salem OR 97301-5157 |
| Practice Telephone | 5033911110 |
| Practice Fax Number | 5033704237 |
| Mailing Telephone | 5033717701 |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2018-04-17 |
| Authorized Official Name | MR. DEAN ANDRETTA (CFO) |
| Authorized Official Telephone | 5033717701 |
| Is Organization Subpart | Y |
| Parent Organization Name | MID VALLEY IPA, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 288533 | 05 |
| Other Name | Type Code |
|---|---|
| WVP The Doctors Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922583616 | Wvp Medical Group, LLC | Clinic/Center | 2995 Ryan Dr Se Ste 200, Salem, OR 97301-5157 | 2018-09-27 |
| 1831504968 | Wvp Medical Group, LLC | Clinic/Center | 2485 12th St. Se, Salem, OR 97302-0000 | 2014-06-27 |
| 1538535059 | Wvp Medical Group, LLC | Clinic/Center | 1430 Monmouth St, Independence, OR 97351-1127 | 2015-08-19 |
| 1710231550 | Wvp Medical Group, LLC | Family Medicine | 2365 Grear St Ne, Salem, OR 97301-2747 | 2012-11-01 |
| 1518225242 | Wvp Medical Group, LLC | Clinic/Center | 1155 Mission St Se, Suite 205, Salem, OR 97302-6228 | 2012-05-01 |
| 1164780060 | Wvp Medical Group, LLC | Clinic/Center | 1000 Se Uglow Ave, Dallas, OR 97338-2645 | 2012-04-27 |
| 1538459938 | Wvp Medical Group, LLC | Clinic/Center | 2478 13th St Se, Ste. 200, Salem, OR 97302-2546 | 2011-04-19 |
| 1750684767 | Wvp Medical Group, LLC | Clinic/Center | 5100 River Rd N, Keizer, OR 97303-5371 | 2010-12-13 |
| 1124352877 | Wvp Medical Group, LLC | Family Medicine | 2485 12th St Se, Salem, OR 97302-2151 | 2009-09-29 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | WVP MEDICAL GROUP, LLC | 245 Commercial St Se Ste 200, Salem, OR 97301 |
| Street Address |
5050 SKYLINE VILLAGE LOOP S |
| City | SALEM |
| State | OR |
| Zip Code | 97306-9490 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972586147 | Myron L Lee | Family Medicine | 5050 Skyline Village Loop S, Salem, OR 97306-9490 | 2005-11-22 |
| 1730655820 | Tamara S Mullins | Nurse Practitioner | 5050 Skyline Village Loop S, Salem, OR 97306-9490 | 2018-10-16 |
| 1578908638 | Troy Sterling Nies | Physician Assistant | 5050 Skyline Village Loop S, Salem, OR 97306-9490 | 2013-05-02 |
| 1174874176 | Grace Whei Kao | Internal Medicine | 5050 Skyline Village Loop S, Salem, OR 97306-9490 | 2012-10-01 |
| 1265743330 | Providence Health & Services Oregon | Clinic/Center | 5050 Skyline Village Loop S, Salem, OR 97306-9490 | 2010-06-23 |
| 1558494294 | Christian Robert Duren | Internal Medicine | 5050 Skyline Village Loop S, Salem, OR 97306-9490 | 2007-03-13 |
| 1215094958 | Ragna Kirsten Rey Rosa | Family Medicine | 5050 Skyline Village Loop S, Salem, OR 97306-9490 | 2007-01-02 |
| 1427152818 | Jay Campbell | Family Medicine | 5050 Skyline Village Loop S, Salem, OR 97306-9490 | 2006-09-07 |
| 1649283060 | Heidi Louise Fletemier | Family Medicine | 5050 Skyline Village Loop S, Salem, OR 97306-9490 | 2006-08-15 |
| 1841275393 | Doctors Clinic LLP | Internal Medicine | 5050 Skyline Village Loop S, Salem, OR 97306-9490 | 2005-12-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134609050 | Andrea P Merryman | Dental Assistant | 5135 Skyline Rd South, Salem, OR 97306 | 2018-08-20 |
| 1215470315 | Anthony Quoc Ngo | Nurse Practitioner | 5050 Skyline Village Loop, Salem, OR 97306 | 2016-11-22 |
| 1134521305 | Wendy Poling | Occupational Therapy Assistant | 1966 Madras St Se Apt 1082, Salem, OR 97306 | 2014-09-19 |
| 1659601045 | Monarch Medical Group LLC | Clinic/Center | 5686 Commercial St Se, Suite 100, Salem, OR 97306 | 2010-01-06 |
| 1316188006 | Judith A Mitchell | Physician Assistant | 4999 Skyline Rd. S., Salem, OR 97306 | 2009-03-10 |
| 1164685574 | Leon Chira | Pharmacist | 2431 Concomly Rd S, Salem, OR 97306 | 2008-07-07 |
| 1912175035 | Salem Clinic, PC | General Practice | 2531 Boone Road Se, Salem, OR 97306 | 2008-02-11 |
| 1326257486 | Robert Allen Long | Physical Therapist | 6250 Commercial St N.e., Salem, OR 97306 | 2007-05-22 |
| 1922137504 | Charlene Garbutt | Dental Assistant | 5135 Skyline Rd. S., Salem, OR 97306 | 2007-03-02 |
| 1417085747 | Michelle West | Dental Assistant | 5135 Skyline R S, Salem, OR 97306 | 2007-02-28 |
| Find all providers in zip 97306 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710373444 | Larry Bassinger | Family Medicine | 1300 Broadway St Ne Ste 104, Salem, OR 97301-1420 | 2015-04-09 |
| 1396144507 | Constance Johanson | Family Medicine | 3959 Croisan Creek Rd S, Salem, OR 97302-9474 | 2014-08-14 |
| 1457792699 | Sultan Seretis Bussey Hospitalist LLC | Family Medicine | 310 Route 45, Salem, NJ 08079-2064 | 2013-07-16 |
| 1629338470 | Derek Koller | Family Medicine | 6861 Lemongrass Loop Se, Salem, OR 97306-1474 | 2012-05-25 |
| 1962712927 | Paul Julian Perrin | Family Medicine | 525 Ferry St Se, Suite 203, Salem, OR 97301 | 2010-10-08 |
| 1326372558 | Robert Verne Bain | Family Medicine | 2280 Kuebler Road, South, Salem, OR 97302 | 2009-09-21 |
| 1902036320 | James A. Auerbach, M.d., P.C. | Family Medicine | 4747 Skyline Rd S, Suite 190, Salem, OR 97306-4200 | 2009-07-20 |
| 1033347430 | Jeanette Walker | Family Medicine | 5560 Witzel Rd Se, Salem, OR 97317-9142 | 2009-06-24 |
| 1871747188 | Carmelle Marie Andrine Constant | Family Medicine | 84 Highland Ave Ste 309, Salem, MA 01970-2733 | 2008-11-13 |
| 1518127927 | Mazen I Madhoun | Family Medicine | 3737 W Main St Ste 101, Salem, VA 24153-2073 | 2008-06-10 |
| Find all providers in SALEM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.