Individual provider Active NPI

Dale E Harris, MD

  • Family Medicine Physician
  • Reedsport, OR
National Provider Identifier
1265464325
Registry record updated Oct 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD14666 Issued in OR
Practice address
620 Ranch Road
Reedsport, OR 97467
Phone
(541) 271-2163
Fax
(541) 271-4058
NPI assigned
Jul 7, 2006
Last updated
Oct 26, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 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 MD14666 OR Primary

Addresses

Primary practice location

620 Ranch Road
Reedsport, OR 97467

Mailing address

620 Ranch Road
Reedsport, OR 97467
Phone (541) 271-2163

Other identifiers 1

IdentifierTypeStateIssuer
276263MedicaidOR

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050117000228 OR Practitioner - Family Practice 1052200219 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lower Umpqua Hospital District CurrentSince Apr 1, 2014 Accepting new patients
Lower Umpqua Hospital District CurrentSince Apr 1, 2014 Accepting new patients
North Bend Medical Center Inc CurrentSince Oct 1, 2018 Accepting new patients

Locations

1900 Woodland Dr
Coos Bay, OR 97420
Phone (541) 267-5151

600 Ranch Rd
Reedsport, OR 97467
Phone (541) 271-2171

620 Ranch Rd
Reedsport, OR 97467
Phone (541) 271-2163

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193356800000",
    "number": "1265464325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 RANCH ROAD",
            "city": "REEDSPORT",
            "state": "OR",
            "postal_code": "97467",
            "telephone_number": "541-271-2163",
            "fax_number": "541-271-4058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 RANCH ROAD",
            "city": "REEDSPORT",
            "state": "OR",
            "postal_code": "97467",
            "telephone_number": "541-271-2163",
            "fax_number": "541-271-4058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "DALE",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2007-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD14666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "276263",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Reedsport, OR

Sources for this page

Verify at the official NPI Registry.