Active NPI
Carrie Atwell Ganong, M.D.
- Pediatrics Physician
- Klamath Falls, OR
National Provider Identifier
1073710778
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 44131
- Practice address
- 3001 Daggett Ave
Klamath Falls, OR 97601-1114 - Phone
- (541) 851-4800
- Fax
- (541) 851-4801
- NPI assigned
- Jun 27, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 44131 | OR | Primary |
Addresses
Primary practice location
3001 Daggett Ave
Klamath Falls, OR 97601-1114
Mailing address
PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 328-6585
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64958960 | Medicaid | KY | |
| 01325653 | Medicaid | CO |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44131 | OR | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366329600000",
"number": "1073710778",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5074",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571175074",
"telephone_number": "605-328-6585",
"fax_number": "605-328-6512"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3001 DAGGETT AVE",
"city": "KLAMATH FALLS",
"state": "OR",
"postal_code": "976011114",
"telephone_number": "541-851-4800",
"fax_number": "541-851-4801"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANONG",
"first_name": "CARRIE",
"middle_name": "ATWELL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-27",
"last_updated": "2013-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OR",
"license": "44131",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64958960",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01325653",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Klamath Falls, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.