Active NPI
Jaime Francisco Serranzana, MD
- General Practice Physician
- Myrtle Creek, OR
National Provider Identifier
1164516365
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 13375
- Practice address
- 925 NW Pacific Hwy
Myrtle Creek, OR 97457 - Phone
- (541) 863-5206
- Fax
- (541) 863-7654
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 13375 | OR | Primary |
Addresses
Primary practice location
925 NW Pacific Hwy
Myrtle Creek, OR 97457
Mailing address
PO Box 2150
Myrtle Creek, OR 91457
Phone (541) 863-5206
Medicare participation
Medicare enrollment files- 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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13375 | OR | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357776000000",
"number": "1164516365",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2150",
"city": "MYRTLE CREEK",
"state": "OR",
"postal_code": "91457",
"telephone_number": "541-863-5206",
"fax_number": "541-863-7654"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "925 NW PACIFIC HWY",
"city": "MYRTLE CREEK",
"state": "OR",
"postal_code": "97457",
"telephone_number": "541-863-5206",
"fax_number": "541-863-7654"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SERRANZANA",
"first_name": "JAIME",
"middle_name": "FRANCISCO",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2013-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "OR",
"license": "13375",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Myrtle Creek, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2013; 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.