Active NPI
Crystal R Dutra, CPM, LDM
- Midwife
- Salem, OR
National Provider Identifier
1245809581
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Midwife
- License
- DEM-LD-10215279
- Practice address
- 1130 Liberty St SE Ste 5
Salem, OR 97302-4143 - Phone
- (503) 930-9934
- NPI assigned
- Jun 21, 2021
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Midwife | 176B00000X | DEM-LD-10215279 | OR | Primary |
Addresses
Primary practice location
1130 Liberty St SE Ste 5
Salem, OR 97302-4143
Mailing address
595 15TH St NE
Salem, OR 97301-2615
Phone (503) 930-9934
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DEM-LD-10215279 | OR | MD | Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624233600000",
"number": "1245809581",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "595 15TH ST NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973012615",
"telephone_number": "503-930-9934"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1130 LIBERTY ST SE STE 5",
"city": "SALEM",
"state": "OR",
"postal_code": "973024143",
"telephone_number": "503-930-9934"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUTRA",
"first_name": "CRYSTAL",
"middle_name": "R",
"credential": "CPM, LDM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-21",
"last_updated": "2021-06-21",
"certification_date": "2021-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "176B00000X",
"taxonomy_group": "",
"desc": "Midwife",
"state": "OR",
"license": "DEM-LD-10215279",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.