NPIMap

Organization Active NPI

Emurgent Care LLC

  • Urgent Care Clinic/Center
  • Dallas, OR
National Provider Identifier
1265871123
Registry record updated Aug 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
EMURGENT CARE LLC
Practice address
109 E Ellendale Ave Ste B
Dallas, OR 97338-1509
Phone
(503) 623-3199
Fax
(503) 623-3398
NPI assigned
Jun 24, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2022

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

Authorized official

Name
Crystal Hasina Kohistani, PA-CNPI 1275943821
Title
Owner
Phone
(612) 306-7403

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X DO27917 OR
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

109 E Ellendale Ave Ste B
Dallas, OR 97338-1509

Mailing address

109 E Ellendale Ave Ste B
Dallas, OR 97338-1509
Phone (503) 623-3199

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131119000265 OR Part B Supplier - Clinic/Group Practice 9830325075 Receives reassigned benefits from 10 practitioners
Practice locations: Dallas, OR

National Provider Directory

National Provider Directory

Locations

109 E Ellendale Ave
Ste B
Dallas, OR 97338
Phone (503) 623-3199

109B E Ellendale Ave
Dallas, OR 97338
Phone (503) 437-3594

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1372032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659312000000",
    "number": "1265871123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 E ELLENDALE AVE STE B",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381509",
            "telephone_number": "503-623-3199",
            "fax_number": "503-623-3398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 E ELLENDALE AVE STE B",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381509",
            "telephone_number": "503-623-3199",
            "fax_number": "503-623-3398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMURGENT CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-24",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A",
        "authorized_official_last_name": "KOHISTANI",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "HASINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-306-7403",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO27917",
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; 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.