NPIMap

Organization Active NPI

Dr Anna LLC

  • Internal Medicine Physician
  • Canyonville, OR
National Provider Identifier
1003210600
Registry record updated Jun 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD26035 Issued in OR
Legal business name
DR ANNA LLC
Practice address
115 S Pine St
Canyonville, OR 97417-9648
Phone
(541) 839-4211
Fax
(541) 839-4983
NPI assigned
Oct 10, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2022

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

Authorized official

Name
Kristie Debaca
Title
Office Manager
Phone
(541) 391-4053

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X MD26035 OR Primary
Clinical Medical Laboratory 291U00000X

Addresses

Primary practice location

115 S Pine St
Canyonville, OR 97417-9648

Mailing address

PO Box 888
Canyonville, OR 97417-0888
Phone (541) 839-4211

Other identifiers 1

IdentifierTypeStateIssuer
R141355OtherORMEDICARE

Other names 1

  • Canyonville Health and Urgent Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141023001846 OR Part B Supplier - Clinic/Group Practice 1254552839 Receives reassigned benefits from 5 practitioners
Practice locations: Canyonville, OR

National Provider Directory

National Provider Directory

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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
38D2107406Canyonville Health and Urgent Care115 S Pine Street, Canyonville, OR 97417Certificate of waiverJan 11, 2028

NPI Registry JSON

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

{
    "created_epoch": "1412899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654560000000",
    "number": "1003210600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 888",
            "city": "CANYONVILLE",
            "state": "OR",
            "postal_code": "974170888",
            "telephone_number": "541-839-4211",
            "fax_number": "541-839-4983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 S PINE ST",
            "city": "CANYONVILLE",
            "state": "OR",
            "postal_code": "974179648",
            "telephone_number": "541-839-4211",
            "fax_number": "541-839-4983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR ANNA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-10",
        "last_updated": "2022-06-07",
        "certification_date": "2022-06-07",
        "status": "A",
        "authorized_official_last_name": "DEBACA",
        "authorized_official_first_name": "KRISTIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "541-391-4053"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD26035",
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "R141355",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyonville Health and Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Canyonville, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.