NPIMap

Organization Active NPI

Bristol Advanced Illness Management - Oregon, L.L.C.

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Springfield, OR
National Provider Identifier
1083364749
Registry record updated Oct 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Internal Medicine) PhysicianTaxonomy code 207RH0002X
Legal business name
BRISTOL ADVANCED ILLNESS MANAGEMENT - OREGON, L.L.C.
Practice address
400 International Way Ste 200
Springfield, OR 97477-7004
Phone
(541) 844-0151
Fax
(541) 656-2722
NPI assigned
Mar 25, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2023

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

Authorized official

Name
Dr. Matthew S Edmonds, MD
Title
Sole Member
Phone
(530) 640-3231

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Internal Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RH0002X Primary

Addresses

Primary practice location

400 International Way Ste 200
Springfield, OR 97477-7004

Mailing address

2002 Timberloch PL Ste 150a
Spring, TX 77380-1198
Phone (281) 899-8470

Other practice location 1

10365 SE Sunnyside Rd Ste 340
Clackamas, OR 97015-5751
Phone (541) 579-2800

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220518000244 OR Part B Supplier - Clinic/Group Practice 9335526060 Receives reassigned benefits from 14 practitioners
Practice locations: Clackamas, OR; Springfield, OR

National Provider Directory

National Provider Directory

Locations

400 International Way
Ste 200
Springfield, OR 97477
Phone (541) 844-0151

400 International Way
Springfield, OR 97477

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1648166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697760000000",
    "number": "1083364749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 TIMBERLOCH PL STE 150A",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773801198",
            "telephone_number": "281-899-8470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 INTERNATIONAL WAY STE 200",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974777004",
            "telephone_number": "541-844-0151",
            "fax_number": "541-656-2722"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10365 SE Sunnyside Rd Ste 340",
            "address_purpose": "LOCATION",
            "city": "Clackamas",
            "state": "OR",
            "postal_code": "970155751",
            "country_code": "US",
            "telephone_number": "541-579-2800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BRISTOL ADVANCED ILLNESS MANAGEMENT - OREGON, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-25",
        "last_updated": "2023-10-20",
        "certification_date": "2023-10-20",
        "status": "A",
        "authorized_official_last_name": "EDMONDS",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "530-640-3231",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RH0002X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.