NPIMap

Individual provider Active NPI

Brooke Davis, DO

  • Family Medicine Physician
  • La Grande, OR
National Provider Identifier
1164839320
Registry record updated Jul 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO198311 Issued in OR
Practice address
506 4TH St
La Grande, OR 97850-1906
Phone
(541) 663-3138
Fax
(541) 975-5120
NPI assigned
Jul 18, 2014
Last updated
Jul 2, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DO198311 OR Primary

Addresses

Primary practice location

506 4TH St
La Grande, OR 97850-1906

Mailing address

3600 NW Samaritan Dr
Corvallis, OR 97330-3737

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200621000012 OR Practitioner - Family Practice 4082036082 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grande Ronde Hospital IncGroup PAC ID 0547170789, 97 clinicians

Practice addresses (Care Compare)

900 Sunset Dr
La Grande, OR 97850-1387
Phone (541) 963-8421

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Grande Ronde Hospital, Inc. Family Medicine CurrentSince Jul 1, 2020 Accepting new patients
Grande Ronde Hospital, Inc. CurrentSince Jul 1, 2020 Accepting new patients

Locations

506 4th St
La Grande, OR 97850
Phone (541) 663-3138

900 Sunset Dr
La Grande, OR 97850
Phone (541) 963-8421

Interoperability endpoints

  • Direct secure messaging: bdavis1251190@wm.providencedirect.org

Organizations & group practices 2

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.

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1405641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593648000000",
    "number": "1164839320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 NW SAMARITAN DR",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 4TH ST",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978501906",
            "telephone_number": "541-663-3138",
            "fax_number": "541-975-5120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "BROOKE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-18",
        "last_updated": "2020-07-02",
        "certification_date": "2020-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO198311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Grande, OR

Sources for this page

Verify at the official NPI Registry.