Individual provider Active NPI

Coeli Dwivedi, LDM, CPM

  • Midwife
  • Ashland, OR
National Provider Identifier
1053520288
Registry record updated Mar 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
MidwifeTaxonomy code 176B00000X
License
DEM-LD-1002847 Issued in OR
Practice address
800 Cambridge St
Ashland, OR 97520-1008
Phone
(541) 488-8324
Fax
(541) 488-8324
NPI assigned
May 22, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 14, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Midwife 176B00000X DEM-LD-1002847 OR Primary

Addresses

Primary practice location

800 Cambridge St
Ashland, OR 97520-1008

Mailing address

800 Cambridge St
Ashland, OR 97520-1008
Phone (541) 488-8324

Other identifiers 1

IdentifierTypeStateIssuer
269634MedicaidOR

Other names 1

  • Gwen Johnson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DEM-LD-1002847ORMDMidwife

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205452800000",
    "number": "1053520288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 CAMBRIDGE ST",
            "city": "ASHLAND",
            "state": "OR",
            "postal_code": "975201008",
            "telephone_number": "541-488-8324",
            "fax_number": "541-488-8324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 CAMBRIDGE ST",
            "city": "ASHLAND",
            "state": "OR",
            "postal_code": "975201008",
            "telephone_number": "541-488-8324",
            "fax_number": "541-488-8324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DWIVEDI",
        "first_name": "COELI",
        "credential": "LDM, CPM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-22",
        "last_updated": "2008-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": "OR",
            "license": "DEM-LD-1002847",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269634",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GWEN",
            "last_name": "JOHNSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Ashland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.