Frederic J Van Dis, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

MD12356 Issued in OR

Practice address

2801 NW Mercy Dr
Ste. 300
Roseburg, OR 97471

Phone

(541) 677-1555

Fax

(541) 677-6543

NPI assigned

Jan 27, 2006

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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Merit-based Incentive Payment System (MIPS)

Final score

83.4 of 100Reported as group

Quality

67.01

Promoting interoperability

99

Improvement activities

40

Cost

78.48

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Roseburg Heart Associates PC

  • Cardiovascular Disease Physician
  • Roseburg, OR
  • NPI 1730308529
  NPD (past) Authorized official
• Centennial Medical Group Inc.

  • Cardiovascular Disease Physician
  • Roseburg, OR
  • NPI 1033365135
  NPD
• Sioux Valley Heart Partners

  • Family Medicine Physician
  • Sioux Falls, SD
  • NPI 1033127956
  NPD (past)

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590451200000",
    "number": "1093786261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 NW MEDICAL LOOP STE 190",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974718835",
            "telephone_number": "541-677-4319",
            "fax_number": "541-677-2294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 NW MERCY DR",
            "address_2": "STE. 300",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "97471",
            "telephone_number": "541-677-1555",
            "fax_number": "541-677-6543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DIS",
        "first_name": "FREDERIC",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-27",
        "last_updated": "2020-05-26",
        "certification_date": "2020-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OR",
            "license": "MD12356",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "060070869",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "MD12356",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114173",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karisa Valance
• Valley Opticians Inc.
• Valley View Mental Health Services, Inc
• Germaine Ann Van Anrooy, RN
• Eden Van Bloem, R.N.
• Lexa Van Volkenburg, OD
• Laurel Lee Vanbeuzekom, LMFT
• David E Vancott, LPC
• Courtney Vanpelt
• Robert Earl Varner, D.M.D.

• Cardiovascular Disease Physician in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Cardiovascular Disease Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.