NPIMap

Organization Active NPI

Allergy & Asthma Center of Southern Oregon PC

  • Allergy Physician
  • Klamath Falls, OR
National Provider Identifier
1164562401
Registry record updated Jul 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy PhysicianTaxonomy code 207KA0200X
Legal business name
ALLERGY & ASTHMA CENTER OF SOUTHERN OREGON PC
Practice address
2628 Clover St
Klamath Falls, OR 97601-1132
Phone
(541) 858-1003
Fax
(541) 857-4499
NPI assigned
Feb 7, 2007
Last updated
Jul 13, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2020

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

Authorized official

Name
Edward Kerwin, MDNPI 1568465847
Title
Physician Owner
Phone
(541) 858-1003

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy Physician 207KA0200X Primary

Addresses

Primary practice location

2628 Clover St
Klamath Falls, OR 97601-1132

Mailing address

3860 Crater Lake Ave
Medford, OR 97504-9741
Phone (541) 858-1003

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070601000084 OR Part B Supplier - Clinic/Group Practice 1355449141 Receives reassigned benefits from 8 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ashland, OR; Grants Pass, OR; Klamath Falls, OR; Medford, OR; Roseburg, OR

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

3860 Crater Lake Ave
Medford, OR 97504
Phone (541) 858-1003

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594598400000",
    "number": "1164562401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3860 CRATER LAKE AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975049741",
            "telephone_number": "541-858-1003",
            "fax_number": "541-857-4499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2628 CLOVER ST",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976011132",
            "telephone_number": "541-858-1003",
            "fax_number": "541-857-4499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLERGY & ASTHMA CENTER OF SOUTHERN OREGON PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2020-07-13",
        "certification_date": "2020-07-13",
        "status": "A",
        "authorized_official_last_name": "KERWIN",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "541-858-1003",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Klamath Falls, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.