Active NPI
Jude Regan Elliott, CPO
- Prosthetist
- Salem, OR
National Provider Identifier
1154845204
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetist
- License
- CPO1930
- Practice address
- 675 12TH St SE
Salem, OR 97301-4002 - Phone
- (503) 581-9191
- NPI assigned
- Jul 31, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetist | 224P00000X | CPO1930 | OR | Primary |
Addresses
Primary practice location
675 12TH St SE
Salem, OR 97301-4002
Mailing address
675 12TH St SE
Salem, OR 97301-4002
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1930 | 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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CPO1930 | OR | MD | Prosthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1501459200000",
"number": "1154845204",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "675 12TH ST SE",
"city": "SALEM",
"state": "OR",
"postal_code": "973014002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "675 12TH ST SE",
"city": "SALEM",
"state": "OR",
"postal_code": "973014002",
"telephone_number": "503-581-9191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIOTT",
"first_name": "JUDE",
"middle_name": "REGAN",
"credential": "CPO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-07-31",
"last_updated": "2017-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "224P00000X",
"taxonomy_group": "",
"desc": "Prosthetist",
"state": "OR",
"license": "CPO1930",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1930",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.