Theresa Jainn Bidwell, FNP/PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA00451 Issued in OR

Practice address

8495 Crater Lake Hwy
118-GV
White City, OR 97503-3011

Phone

(541) 826-2111

NPI assigned

Jun 6, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485129600000",
    "number": "1114966819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 943",
            "city": "GOLD HILL",
            "state": "OR",
            "postal_code": "975250943",
            "telephone_number": "541-821-1919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8495 CRATER LAKE HWY",
            "address_2": "118-GV",
            "city": "WHITE CITY",
            "state": "OR",
            "postal_code": "975033011",
            "telephone_number": "541-826-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIDWELL",
        "first_name": "THERESA",
        "middle_name": "JAINN",
        "name_prefix": "Ms.",
        "credential": "FNP/PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-06",
        "last_updated": "2017-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA00451",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "392031",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Arthur Beech, RN
• Carol Ann Berger, OT/R
• Ralph William Bergstrom Jr., M.D.
• Monique Neto Bettencourt
• Grace Katherine Beyer, PHARMD
• Matthew Thomas Blakeley, PSY.D.
• Whitney Anne Bondshu, MSW
• Samuel Lester Bookey, LCSW
• Danielle C Booth
• Alison Michelle Bosler, CPO

• Medical Physician Assistant in White City, OR
• Providers in White City, OR by specialty
• Medical Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.