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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

MOUSSA OMIDVAR
NPI 1639672678
Radiology - Vascular & Interventional Radiology 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: August 19, 2026. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Aug 19, 2026, Mar 15, 2018 (2 updates tracked since 2018).

About Moussa Omidvar NPPES

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

MOUSSA OMIDVAR (NPI 1639672678) is an individual vascular & interventional radiology provider in Lebanon, Oregon, licensed in Texas (W8603) and active in the NPI registry since March 2018. He is enrolled in Medicare PECOS and maintains a secondary practice location in San Angelo.

NPPES Registry Identity

NPI1639672678
Entity TypeIndividualMale
Primary Taxonomy2085R0204X
Provider Legal NameMOUSSA OMIDVAR
Location Address200 MULLINS DRLebanon, OR 97355-3983
Mailing Address120 E Harris AveSan Angelo, TX 76903-5904 · (325) 747-6741
Phone(541) 259-0200
Sole ProprietorNo
Enumeration DateMarch 15, 2018
Last NPPES UpdateAugust 19, 20262 updates tracked since enumeration
NPPES CertifiedAugust 19, 2026
✔ NPI 1639672678 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyRadiology · Vascular & Interventional RadiologyAllopathic & Osteopathic Physicians
Taxonomy Code2085R0204X
License✔ Licensed in TX · W8603
Definition
A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging.
200 MULLINS DR, Lebanon, OR 97355
Open in Google Maps ↗

Secondary Practice Location 1

Location 1120 E Harris AveSan Angelo, TX 76903-5904 · Phone (325) 747-6741

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 97355 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.82 typical visit price
range $54.96 – $166.64
Typical copayment $21.20 (range $13.74 – $41.66)
Most-billed visit code 99203
Established Patient
$68.64 typical visit price
range $17.68 – $136.19
Typical copayment $17.16 (range $4.42 – $34.04)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

JALINA MUELLER
General Practice
200 MULLINS DR
LEBANON, OR 97355
Linn County (541) 908-4101
SAISWATHI PATEL
Psychiatry & Neurology (Psychiatry)
200 MULLINS DR
LEBANON, OR 97355
Linn County (541) 259-0235
HEATHER CHRISTIANSON
Family Medicine
200 MULLINS DR
LEBANON, OR 97355
Linn County (541) 259-0200
HALEY E SANCHEZ
Internal Medicine
200 MULLINS DR
LEBANON, OR 97355
Linn County (541) 259-0235
JESSICA WALLACE
Student in an Organized Health Care Education/Training Program
200 MULLINS DR
LEBANON, OR 97355
Linn County (541) 259-0235
KAYLA TRENTER
Student in an Organized Health Care Education/Training Program
200 MULLINS DR
LEBANON, OR 97355
Linn County (541) 259-0235
NGHIA LE
Student in an Organized Health Care Education/Training Program
200 MULLINS DR
LEBANON, OR 97355
Linn County (541) 259-0235
JOCELYN POWELL
Student in an Organized Health Care Education/Training Program
200 MULLINS DR
LEBANON, OR 97355
Linn County (541) 207-8321

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 Radiology, specializing in Vascular & Interventional Radiology, with taxonomy code 2085R0204X.

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 August 19, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.