Andre Luiz Bezerra, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

10053410 Issued in OR

Practice address

1701 NW Hawthorne Ave
Grants Pass, OR 97526-1051

Phone

(541) 472-4777

Fax

(541) 471-1439

NPI assigned

Jan 28, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL, OR2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Siskiyou Community Health Center IncGroup PAC ID 6305747288, 30 clinicians

Mayo Clinic JacksonvilleGroup PAC ID 5698689297, 1,595 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Asante Three Rivers Medical Center Hospital, Grants Pass, OR, CCN 380002

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Mayo Clinic Jacksonville

  • Multi-Specialty Clinic/Center
  • Jacksonville, FL
  • NPI 1790772317

  FL

  Medicare reassignment Care Compare group NPD
• Siskiyou Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Grants Pass, OR
  • NPI 1427046903

  OR

  Medicare reassignment Care Compare group NPD (past)
• Mayo Clinic Jacksonville

  • Home Infusion Therapy Pharmacy
  • Jacksonville, FL
  • NPI 1003510116
  NPD
• Mayo Clinic Jacksonville

  • Health Service Clinic/Center
  • Jacksonville, FL
  • NPI 1174143986
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Asante Three Rivers Medical Center, LLC

  • General Acute Care Hospital
  • Grants Pass, OR
  • NPI 1801891809

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1738022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775174400000",
    "number": "1093528655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 NW HAWTHORNE AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975261051",
            "telephone_number": "541-472-4777",
            "fax_number": "541-471-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 NW HAWTHORNE AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975261051",
            "telephone_number": "541-472-4777",
            "fax_number": "541-471-1439"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25647 Redwood Hwy",
            "address_purpose": "LOCATION",
            "city": "Cave Junction",
            "state": "OR",
            "postal_code": "975239332",
            "country_code": "US",
            "telephone_number": "541-592-4111",
            "fax_number": "541-592-3916",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BEZERRA",
        "first_name": "ANDRE",
        "middle_name": "LUIZ",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-01-28",
        "last_updated": "2026-04-03",
        "certification_date": "2026-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OR",
            "license": "10053410",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500867922",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Haley Berry, LMT
• Wendy J Bertolino, LMT
• Pamela Lynn Betsworth, LMT
• Kristina Melody Lassfolk Bettencourt, PHARMD
• Kristin Bezdek
• Kimberly G Bibeau, LAC
• Maia Bierwirth, LMT
• Bigelow and Pastrell Dentistry
• Gregory Nelson Bigelow, D.M.D.
• Cody Biller, PHARMD

• Nurse Practitioner in Grants Pass, OR
• Providers in Grants Pass, OR by specialty
• Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.