Organization Active NPI

Jacqueline Amato MD PC

  • Psychiatry Physician
  • Medford, OR
National Provider Identifier
1215447008
Registry record updated Oct 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
22816 Issued in OR
Legal business name
JACQUELINE AMATO MD PC
Practice address
841 Alder Creek Dr
Medford, OR 97504-8900
Phone
(541) 858-7188
Fax
(541) 858-7186
NPI assigned
Oct 5, 2017
Last updated
Oct 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2023

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

Authorized official

Name
Debbie Jewell
Title
Office Manager
Phone
(541) 858-7188

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 22816 OR Primary

Addresses

Primary practice location

841 Alder Creek Dr
Medford, OR 97504-8900

Mailing address

841 Alder Creek Dr
Medford, OR 97504-8900
Phone (541) 858-7188

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171109001795 OR Part B Supplier - Clinic/Group Practice 1355607276 Receives reassigned benefits from 1 practitioner
Practice locations: Medford, OR

National Provider Directory

National Provider Directory

Locations

841 Alder Creek Dr
Medford, OR 97504
Phone (541) 842-2020

Practitioners & affiliated clinicians

Practitioners 2

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": "1507161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697587200000",
    "number": "1215447008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "841 ALDER CREEK DR",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048900",
            "telephone_number": "541-858-7188",
            "fax_number": "541-858-7186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 ALDER CREEK DR",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048900",
            "telephone_number": "541-858-7188",
            "fax_number": "541-858-7186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACQUELINE AMATO MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-05",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A",
        "authorized_official_last_name": "JEWELL",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "541-858-7188"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OR",
            "license": "22816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; 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.