Michael Edward Bisgrove, M.D.
Individual provider Active NPI Family Medicine Physician · Brookings, OR
NPI 1104856046 · NPPES record last updated Jan 4, 2011
Key facts
- NPI
- 1104856046
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 0101039643 (VA)
- Practice address
- 555 5TH St
Suite #1
Brookings, OR 97415-9730 - Phone
- (541) 412-1152
- Fax
- (541) 412-1842
- NPI assigned
- Jul 4, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140430000598 | OR | Order and Referring Only - Family Practice |
7416180310 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gibson Community Hospital Association | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0101039643 | VA | Yes |
Addresses
Primary practice location
555 5TH St
Suite #1
Brookings, OR 97415-9730
Mailing address
555 5TH St
Suite #1
Brookings, OR 97415-9730
Phone (541) 412-1152
Other providers in Brookings, OR
- Suzanne Bedke
- Ashley N Benson
- Hazel Berry
- Better Health Family Medical, LLC
- Raechele Darleen Bird
- Michelle L Bishop
- Jeanne A. Bisson
- Wendy Blymyer
- Ronald Dustin Bodman
- Shannon Bonde
All providers in Brookings, OR · Family Medicine Physician in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 4, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.