Micheline I Cavallacci, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1600 Delta Waters Rd
Suite 107
Medford, OR 97504-9114

Phone

(541) 858-2515

Fax

(541) 858-2514

NPI assigned

Dec 5, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Micheline I Sand Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Emergency Physicians of Naples PLLC

  • Emergency Medicine Physician
  • Naples, FL
  • NPI 1861410656
  NPD (past)
• Naples Emergency Physicians LLC

  • Nurse Practitioner
  • Naples, FL
  • NPI 1598748006

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1235113994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 N CENTRAL AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975015873",
            "telephone_number": "541-734-9030",
            "fax_number": "541-734-9885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 DELTA WATERS RD",
            "address_2": "SUITE 107",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975049114",
            "telephone_number": "541-858-2515",
            "fax_number": "541-858-2514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAVALLACCI",
        "first_name": "MICHELINE",
        "middle_name": "I",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-05",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA2939",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "PA175803",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291580400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELINE",
            "last_name": "SAND",
            "middle_name": "I",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Joseph Cataldo
• Cataract and Laser Institute of Southern Oregon PC
• Melissa J Cate
• Alexandra Grace Caton
• James C. Catt, D.M.D.
• Kyra Cavalli
• Travis Cavalli, CADC 1
• Nancy Alexandria Cavanaugh, PNP
• Shawni Cayetano-Ramos
• Weston Jay Caywood, M.D.

• Physician Assistant in Medford, OR
• Providers in Medford, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.

Verify at the official NPI Registry.