Active NPI
Patrick K Lewallen, MD
- Neonatal-Perinatal Medicine Physician
- Bend, OR
National Provider Identifier
1184722795
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neonatal-Perinatal Medicine Physician
- License
- MD14318
- Practice address
- 2500 NE Neff Rd
Bend, OR 97701-6015 - Phone
- (541) 382-4321
- Fax
- (541) 706-7068
- NPI assigned
- Sep 20, 2006
- 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 |
|---|---|---|---|---|
| Neonatal-Perinatal Medicine Physician | 2080N0001X | MD14318 | OR | Primary |
Addresses
Primary practice location
2500 NE Neff Rd
Bend, OR 97701-6015
Mailing address
501 N Graham Street
Suite 265
Portland, OR 97227
Phone (503) 282-7002
Other practice location 1
501 N Graham Street
Suite 265
Portland, OR 97227
Phone (503) 282-7002
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 125658 | Medicaid | OR |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | plewallen19277@secure.stcharleshealthcare.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD14318 | OR | MD | Neonatal-Perinatal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Charles Health System, Inc. | Current | Accepting new patients | |
| St. Charles Health System, Inc. | Current | Accepting new patients | |
| St. Charles Health System, Inc. | Current | Accepting new patients | |
| Northwest Newborn Specialists PC | Neonatal-Perinatal Medicine | Past | Accepting new patients |
Locations
29358 Network Pl
Chicago, IL 60673
2500 NE Neff Rd
Bend, OR 97701
Phone (541) 388-4333
1253 NW Canal Blvd
Redmond, OR 97756
Phone (541) 548-8131
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.
-
- General Acute Care Hospital
- Bend, OR
- NPI 1982621447
-
- Rehabilitation Hospital Unit
- Bend, OR
- NPI 1154343150
-
- Rural Health Clinic/Center
- Prineville, OR
- NPI 1407178528
-
- Neonatal-Perinatal Medicine Physician
- Orange, CA
- NPI 1235135302
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587340800000",
"number": "1184722795",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 N GRAHAM STREET",
"address_2": "SUITE 265",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97227",
"telephone_number": "503-282-7002",
"fax_number": "503-280-1290"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 NE NEFF RD",
"city": "BEND",
"state": "OR",
"postal_code": "977016015",
"telephone_number": "541-382-4321",
"fax_number": "541-706-7068"
}
],
"practiceLocations": [
{
"address_1": "501 N Graham Street",
"address_2": "Suite 265",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "97227",
"country_code": "US",
"telephone_number": "503-282-7002",
"fax_number": "503-280-1290",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LEWALLEN",
"first_name": "PATRICK",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2020-04-20",
"certification_date": "2020-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "2080N0001X",
"taxonomy_group": "",
"desc": "Pediatrics, Neonatal-Perinatal Medicine",
"state": "OR",
"license": "MD14318",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "125658",
"state": "OR"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "plewallen19277@secure.stcharleshealthcare.org",
"affiliation": "N",
"address_1": "2500 NE Neff Rd",
"city": "Bend",
"state": "OR",
"country_code": "US",
"postal_code": "977016015",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2020; 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.