Active NPI
James K Detwiler, MD
- Family Medicine Physician
- Redmond, OR
National Provider Identifier
1154364024
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD09568
- Practice address
- 211 NW Larch Ave
Redmond, OR 97756-1357 - Phone
- (541) 548-2164
- Fax
- (541) 548-0534
- NPI assigned
- Jun 14, 2006
- Last updated
- Feb 7, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD09568 | OR | Primary |
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | MD09568 | OR | |
| Aerospace Medicine Physician | 2083A0100X | MD09568 | OR | |
| Occupational Medicine Physician | 2083X0100X | MD09568 | OR |
Addresses
Primary practice location
211 NW Larch Ave
Redmond, OR 97756-1357
Mailing address
PO Box 1420
Redmond, OR 97756-0400
Phone (541) 548-2164
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11129522 | Other | OR | CAQH ID |
| 233692 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328572800000",
"number": "1154364024",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1420",
"city": "REDMOND",
"state": "OR",
"postal_code": "977560400",
"telephone_number": "541-548-2164",
"fax_number": "541-548-0534"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 NW LARCH AVE",
"city": "REDMOND",
"state": "OR",
"postal_code": "977561357",
"telephone_number": "541-548-2164",
"fax_number": "541-548-0534"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DETWILER",
"first_name": "JAMES",
"middle_name": "K",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-14",
"last_updated": "2012-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "MD09568",
"primary": true
},
{
"code": "207QG0300X",
"taxonomy_group": "",
"desc": "Family Medicine, Geriatric Medicine",
"state": "OR",
"license": "MD09568",
"primary": false
},
{
"code": "2083A0100X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Aerospace Medicine",
"state": "OR",
"license": "MD09568",
"primary": false
},
{
"code": "2083X0100X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Occupational Medicine",
"state": "OR",
"license": "MD09568",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH ID",
"identifier": "11129522",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "233692",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Redmond, OR
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- Desert Peaks Health Care, LLC
- Derek Devol
- Anthony Dicenzo, LMFT
- Discover Chiropractic Redmond
- Lester Jonathan Dixon, MD
- Steven Dobson
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.