Active NPI
Sally Suzanne Marie, MD
- Family Medicine Physician
- Eugene, OR
National Provider Identifier
1275500050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD14482
- Practice address
- 1755 Coburg Rd Ste 5
Eugene, OR 97401-4982 - Phone
- (541) 654-4175
- Fax
- (541) 844-1291
- NPI assigned
- Mar 1, 2006
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD14482 | OR | Primary |
Addresses
Primary practice location
1755 Coburg Rd Ste 5
Eugene, OR 97401-4982
Mailing address
1755 Coburg Rd Ste 5
Eugene, OR 97401-4982
Phone (541) 654-4175
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 142976 | Medicaid | OR |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD14482 | OR | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323129600000",
"number": "1275500050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1755 COBURG RD STE 5",
"city": "EUGENE",
"state": "OR",
"postal_code": "974014982",
"telephone_number": "541-654-4175",
"fax_number": "541-844-1291"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1755 COBURG RD STE 5",
"city": "EUGENE",
"state": "OR",
"postal_code": "974014982",
"telephone_number": "541-654-4175",
"fax_number": "541-844-1291"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARIE",
"first_name": "SALLY",
"middle_name": "SUZANNE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-01",
"last_updated": "2011-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "MD14482",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "142976",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.