Active NPI
Madras Medical Group P.C.
- Family Medicine Physician
- Madras, OR
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- MADRAS MEDICAL GROUP P.C.
- Practice address
- 76 NE 12TH St
Madras, OR 97741-1827 - Phone
- (541) 475-3874
- Fax
- (541) 475-3503
- NPI assigned
- May 18, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. David V Evans, MD
- Title
- Vice President
- Phone
- (541) 475-3874
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
76 NE 12TH St
Madras, OR 97741-1827
Mailing address
76 NE 12TH St
Madras, OR 97741-1827
Phone (541) 475-3874
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040407001171 | OR | Part B Supplier - Clinic/Group Practice | 5597758102 |
Receives reassigned benefits from 9 practitioners Practice locations: Madras, OR |
| O20050906000920 | OR | Part A Provider - Rural Health Clinic | 5597758102 | Practice locations: Madras, OR |
Rural health clinic certification: CCN 383859
- Legal name
- MADRAS MEDICAL GROUP PC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Dec 8, 2005
- Last certification
- Mar 26, 2025
- Ownership / control type
- 1B
- Organization structure
- Corporation
- Incorporated
- Oct 19, 1973 in OR
- Enrollment address
- 76 NE 12TH St
Madras, OR 97741-1827
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 38D0628393 | Madras Medical Group | Provider-performed microscopy | Dec 31, 2027 |
National Provider Directory
National Provider DirectoryLocations
76 NE 12th St
Madras, OR 97741
Phone (541) 475-3874
Interoperability endpoints
- https://api.platform.athenahealth.com/14009/brand/1/csg/1/fhir/r4
Ownership & related parties
All disclosed owners & managing parties 3
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Gary M Plant | 5% Or Greater Direct Ownership Interest | Jul 1, 2012 | |
| General Partnership Interest | Jul 1, 2012 | ||
| Corporate Officer | Jul 1, 2012 | ||
| Kristine M Delamarter | 5% Or Greater Direct Ownership Interest | Jul 1, 2012 | |
| General Partnership Interest | Jul 1, 2012 | ||
| Corporate Officer | Jul 1, 2012 | ||
| Robert Jones | Operational/Managerial Control | Jul 1, 2012 |
Owners & managing parties with NPI records 2
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Family Medicine Physician
- Madras, OR
- NPI 1902018757
5% Or Greater Direct Ownership Interest, Corporate Officer, General Partnership Interest
-
- Family Medicine Physician
- Madras, OR
- NPI 1417900317
5% Or Greater Direct Ownership Interest, Corporate Officer, General Partnership Interest
Practitioners & affiliated clinicians
Practitioners 11
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Durham, NC
- NPI 1407242969
Family Medicine, OR
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147910400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1242777600000",
"number": "1093768533",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "76 NE 12TH ST",
"city": "MADRAS",
"state": "OR",
"postal_code": "977411827",
"telephone_number": "541-475-3874",
"fax_number": "541-475-3503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "76 NE 12TH ST",
"city": "MADRAS",
"state": "OR",
"postal_code": "977411827",
"telephone_number": "541-475-3874",
"fax_number": "541-475-3503"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MADRAS MEDICAL GROUP P.C.",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-18",
"last_updated": "2009-05-20",
"status": "A",
"authorized_official_last_name": "EVANS",
"authorized_official_first_name": "DAVID",
"authorized_official_middle_name": "V",
"authorized_official_title_or_position": "VICE PRESIDENT",
"authorized_official_telephone_number": "541-475-3874",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madras, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- 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.