NPIMap

Individual provider Active NPI

Diane Bolduc, M.D.

  • Family Medicine Physician
  • Roseburg, OR
National Provider Identifier
1174537047
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD23487 Issued in OR
Practice address
340 Medical Loop
Roseburg, OR 97470-1645
Phone
(541) 464-5907
Fax
(541) 464-8481
NPI assigned
Jul 28, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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 MD23487 OR Primary

Addresses

Primary practice location

340 Medical Loop
Roseburg, OR 97470-1645

Mailing address

340 Medical Loop
Roseburg, OR 97470-1645
Phone (541) 464-5907

Other identifiers 5

IdentifierTypeStateIssuer
287185MedicaidOR
840254000OtherORREGENCE BLUE CROSS
J103601OtherORPACIFIC SOURCE
32945700000OtherPROVIDENCE HEALTH PLANS
608828900OtherBLACK LUNG FEDERAL PROGRA

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
I20040728000594 OR Practitioner - Family Practice 8123098175 Receives reassigned benefits from 8 practitioners
Practice locations: Roseburg, OR

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

340 Medical Loop
Roseburg, OR 97470-1645

340 Nwmedical Loop
Roseburg, OR 97471-1645
Phone (541) 464-5907

Hospital & facility affiliations

  • Amedisys Home Health Care Home health agency, Roseburg, OR, CCN 387311
  • Mercy Medical Center Hospital, Roseburg, OR, CCN 380027

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
White Oak Medical Clinic LLC Family Medicine Current Accepting new patients
Adequate Care Hospice Inc Family Medicine Current Accepting new patients
White Oak Medical Clinic LLC Family Medicine CurrentSince Sep 1, 2004 Accepting new patients
Douglas Medical Clinic PC Family Medicine Past Accepting new patients

Locations

340 NW Medical Loop
Roseburg, OR 97471
Phone (541) 464-5907

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CFGBCD

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1174537047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 MEDICAL LOOP",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974701645",
            "telephone_number": "541-464-5907",
            "fax_number": "541-464-8481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 MEDICAL LOOP",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974701645",
            "telephone_number": "541-464-5907",
            "fax_number": "541-464-8481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLDUC",
        "first_name": "DIANE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-28",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD23487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287185",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE CROSS",
            "identifier": "840254000",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PACIFIC SOURCE",
            "identifier": "J103601",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDENCE HEALTH PLANS",
            "identifier": "32945700000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG FEDERAL PROGRA",
            "identifier": "608828900",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseburg, OR

Sources for this page

Verify at the official NPI Registry.