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MOUSSA OMIDVAR
NPI 1639672678
Student in an Organized Health Care Education/Training Program in Lebanon, OR

Active since March 15, 2018PECOS Enrolled
200 MULLINS DR, LEBANON, OR 97355(541) 259-0200 Get Directions Write a Review

NPPES record last updated: March 15, 2018. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Moussa Omidvar NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MOUSSA OMIDVAR (NPI 1639672678) is an individual student in an organized health care education/training program in Lebanon, Oregon and active in the NPI registry since March 2018. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1639672678
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameMOUSSA OMIDVAR
Location Address200 MULLINS DRLebanon, OR 97355-3983
Mailing Address200 Mullins DrLebanon, OR 97355-3983 · (541) 259-0200
Phone(541) 259-0200
Sole ProprietorNo
Enumeration DateMarch 15, 2018
✔ NPI 1639672678 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

200 MULLINS DR, Lebanon, OR 97355
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Moussa Omidvar is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LAUREN DALLAS
Student in an Organized Health Care Education/Training Program
200 MULLINS DR
LEBANON, OR 97355
Linn County (815) 353-6886
BRADLEY THOMAS MICHEL
Student in an Organized Health Care Education/Training Program
200 MULLINS DR
LEBANON, OR 97355
Linn County (541) 248-1812
ROBYN LYNN DREIBELBIS DO
Family Medicine
200 MULLINS DR
LEBANON, OR 97355
Linn County (541) 259-0216
WESTERN UNIVERSITY OF HEALTH SCIENCES
Family Medicine (Adult Medicine)
200 MULLINS DR
LEBANON, OR 97355
Linn County (541) 259-0200
KRISTINA SOMAN-FAULKNER
Student in an Organized Health Care Education/Training Program
200 MULLINS DR
LEBANON, OR 97355
Linn County (541) 259-0200
SHANE CANRIGHT
Student in an Organized Health Care Education/Training Program
200 MULLINS DR
LEBANON, OR 97355
Linn County (503) 313-5982
KELSEY BARAN
Student in an Organized Health Care Education/Training Program
200 MULLINS DR
LEBANON, OR 97355
Linn County (651) 231-5885
BENIAMIN CORNELIU TODOR
Student in an Organized Health Care Education/Training Program
200 MULLINS DR
LEBANON, OR 97355
Linn County (541) 259-0200

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Moussa Omidvar's NPI number?

The NPI number for Moussa Omidvar is 1639672678. It was assigned to this individual provider in the NPPES registry on March 15, 2018.

Where is Moussa Omidvar located?

Moussa Omidvar practices at 200 Mullins Dr, Lebanon, OR 97355. The listed phone number is (541) 259-0200.

What is Moussa Omidvar's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Moussa Omidvar enrolled in Medicare?

Yes. Moussa Omidvar is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Moussa Omidvar was last updated on March 15, 2018. NPI Profile syncs with the weekly NPPES data releases published by CMS.