Deric V Ravsten, D.O.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

DO219571 Issued in OR

Practice address

621 W Madrone St Ste 330
Roseburg, OR 97470-3090

Phone

(541) 672-2691

Fax

(877) 284-2783

NPI assigned

Aug 30, 2006

Last updated

Mar 17, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in ID, TX, OR3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Specialty

Psychiatry

Education

Des Moines University of Osteopathic Medicine and Health Sciences, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

AdaptGroup PAC ID 4587662887, 43 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Medical Center Hospital, Roseburg, OR, CCN 380027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Adapt

  • Addiction (Substance Use Disorder) Counselor
  • Roseburg, OR
  • NPI 1720010549
  Medicare reassignment Care Compare group NPD
• Life Change Associates, PC

  • Psychiatry Physician
  • Pocatello, ID
  • NPI 1598077562
  Medicare reassignment Authorized official
• Shoshone Bannock Tribes, Inc

  dba Shoshone-Bannock Community Health Center

  • Clinic/Center
  • Fort Hall, ID
  • NPI 1225414519

  TX

  Medicare reassignment
• Adapt

  dba Adapt Integrated Health Care

  • Federally Qualified Health Center (FQHC)
  • Bandon, OR
  • NPI 1194529289
  NPD
• Adapt

  dba Adapt Integrated Health Care

  • Community/Behavioral Health Agency
  • Brookings, OR
  • NPI 1760145338
  NPD
• Adapt

  dba SouthRiver Medical Clinic aka: SouthRiver Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Winston, OR
  • NPI 1912061755
  NPD (past)
• Four Corners Community Behavioral Health Inc

  dba Operation Recovery

  • Methadone Clinic
  • Price, UT
  • NPI 1164048492
  NPD (past)
• Four Corners Community Behavioral Health, Inc.

  • Community/Behavioral Health Agency
  • Price, UT
  • NPI 1487715330
  NPD (past)
• Shoshone-Bannock Community Health Center

  dba Shoshone-Bannock Tribes

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Fort Hall, ID
  • NPI 1225570716
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Commonspirit Oregon

  dba CHI Mercy Medical Center

  • General Acute Care Hospital
  • Roseburg, OR
  • NPI 1477590198
  Care Compare affiliation

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742169600000",
    "number": "1154431542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1121",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974700254",
            "telephone_number": "541-672-2691",
            "fax_number": "877-284-2783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 W MADRONE ST STE 330",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974703090",
            "telephone_number": "541-672-2691",
            "fax_number": "877-284-2783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAVSTEN",
        "first_name": "DERIC",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2025-03-17",
        "certification_date": "2025-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ID",
            "license": "O-290",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OR",
            "license": "DO219571",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD OF ID",
            "identifier": "000010154744",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806453300",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "S6444",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jo Dena Rankin-Searles, QMHA
• Elle Flury Rappe, LMSW
• Patricia Rasmussen, APRN, FNP-BC
• Jawairiya Rasool, MBBS, MPH, MBA
• Debra J Raumakita, APNP
• Sara Ray, MSN, RN, OCN
• Paulette Ilene Raymond, RN
• Daniel Morgan Read
• Kaleigh Reddekopp
• Laurene Elizabeth Reed, DO

• Psychiatry Physician in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Psychiatry Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2025; 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.
• 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.