Individual provider Active NPI

Bruce A McLellan, M.D.

  • Interventional Cardiology Physician
  • Bend, OR
National Provider Identifier
1043290398
Registry record updated Dec 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
MD15503 Issued in OR
Practice address
2500 NE Neff Rd
Bend, OR 97701-6015
Phone
(541) 388-1636
Fax
(541) 388-1719
NPI assigned
Jan 20, 2006
Last updated
Dec 7, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD15503 OR
Cardiovascular Disease Physician 207RC0000X MD15503 OR
Interventional Cardiology Physician 207RI0011X MD15503 OR Primary

Addresses

Primary practice location

2500 NE Neff Rd
Bend, OR 97701-6015

Mailing address

PO Box 5579
Bend, OR 97708-5579
Phone (541) 388-1636

Other identifiers 1

IdentifierTypeStateIssuer
208371MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031111000825 OR Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 4981517976 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
15503ORMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
McKenzie Physician Services LLC CurrentSince Mar 18, 2014 Accepting new patients
Blue Mountain Hospital District Cardiovascular Disease CurrentSince Jul 30, 2012 Accepting new patients
Blue Mountain Hospital District CurrentSince Jul 30, 2012 Accepting new patients
St. Charles Health System, Inc. Past Accepting new patients

Locations

1501 NE Medical Center Dr
Bend, OR 97701
Phone (541) 317-4354

1750 Thompson Rd
Coos Bay, OR 97420
Phone (541) 269-0333

170 Ford Rd
John Day, OR 97845
Phone (541) 575-1311

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/4fb2ef4c-fc22-4675-b38f-5641155a5454/

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670371200000",
    "number": "1043290398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5579",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977085579",
            "telephone_number": "541-388-1636",
            "fax_number": "541-388-1719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 NE NEFF RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016015",
            "telephone_number": "541-388-1636",
            "fax_number": "541-388-1719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCLELLAN",
        "first_name": "BRUCE",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-20",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD15503",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OR",
            "license": "MD15503",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "OR",
            "license": "MD15503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208371",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.