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WVP MEDICAL GROUP- BOULDER CREEK
NPI 1831504968
Clinic/Center in Salem, OR

Active since June 27, 2014
2485 12TH ST. SE, SALEM, OR 97302(503) 363-8047(503) 363-6571 Get Directions Write a Review

NPPES record last updated: June 27, 2014. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Wvp Medical Group- Boulder Creek NPPES

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

WVP MEDICAL GROUP- BOULDER CREEK (NPI 1831504968) is a healthcare organization registered as a clinic/center in Salem, Oregon and active in the NPI registry since June 2014. The organization lists Dean Andretta, Cfo, as its authorized official.

NPPES Registry Identity

NPI1831504968
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameWVP MEDICAL GROUP, LLC
Location Address2485 12TH ST. SESalem, OR 97302-0000
Mailing Address2485 12th St. SeSalem, OR 97302-0000
Phone(503) 363-8047
Fax(503) 363-6571
Organization SubpartYesParent: Mid Valley Ipa, Inc
Authorized OfficialDean AndrettaCfo · (503) 371-7701
Enumeration DateJune 27, 2014
✔ NPI 1831504968 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
2485 12TH ST. SE, Salem, OR 97302
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Other Names 1

Doing Business AsWvp Medical Group- Boulder Creek

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Wvp Medical Group- Boulder Creek is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Wvp Medical Group- Boulder Creek, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (2)

Mindi Burdick, FNP-C
Nurse Practitioner
NPI 1245808047
2995 RYAN DR SE STE 200
Salem, OR 97301
(503) 371-7701
✔ PECOS✔ Accepts Medicare1.5 mi
James Tomasevich, LCSW, CADC II
Clinical Social Worker
NPI 1013099522
3995 MARCOLA ROAD
Springfield, OR 97477
(541) 726-1465
✔ PECOS✔ Accepts Medicare59 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Wvp Medical Group, LLC's NPI number?

The NPI number for Wvp Medical Group, LLC is 1831504968. It was assigned to this organization in the NPPES registry on June 27, 2014. The provider is doing business as Wvp Medical Group- Boulder Creek.

Where is Wvp Medical Group, LLC located?

Wvp Medical Group, LLC is located at 2485 12th St. SE, Salem, OR 97302. The listed phone number is (503) 363-8047.

What is Wvp Medical Group, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Is Wvp Medical Group, LLC enrolled in Medicare?

Yes. Wvp Medical Group, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Wvp Medical Group, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Wvp Medical Group, LLC, in Clinical Social Worker and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Wvp Medical Group, LLC was last updated on June 27, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years 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.