Individual provider Active NPI

Stephanie Alice Trautman, MD

  • Dermatology Physician
  • Bend, OR
National Provider Identifier
1275744971
Registry record updated Aug 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MD28337 Issued in OR
Practice address
2747 NE Conners Ave
Bend, OR 97701-8738
Phone
(541) 382-5712
NPI assigned
May 24, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X MD28337 OR Primary

Addresses

Primary practice location

2747 NE Conners Ave
Bend, OR 97701-8738

Mailing address

19638 Hollygrape St
Bend, OR 97702-2688
Phone (360) 261-3111

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
I20080728000186 OR Practitioner - Dermatology 7315010196 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Texas Southwestern Medical School at Dallas, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain West Derm - Blackhart PLLCGroup PAC ID 1153609813, 103 clinicians

Practice addresses (Care Compare)

2747 NE Conners Ave
Bend, OR 97701-8738
Phone (541) 382-5712

Hospital & facility affiliations

  • Ohsu Hospital and Clinics Hospital, Portland, OR, CCN 380009
  • St Charles Medical Center - Bend Hospital, Bend, OR, CCN 380047

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision17
Removal of tissue1-10
Removal of skin lesions2644
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy368

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain West Derm-Blackhart, PLLC Dermatology CurrentSince Feb 1, 2018 Accepting new patients
Mountain West Derm - Blackhart PLLC Dermatology CurrentSince Feb 1, 2018 Accepting new patients
Mountain West Derm - Blackhart PLLC Dermatology Past Accepting new patients

Locations

2747 NE Conners Ave
Bend, OR 97701
Phone (541) 322-1980

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 and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470268800000",
    "number": "1275744971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19638 HOLLYGRAPE ST",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977022688",
            "telephone_number": "360-261-3111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2747 NE CONNERS AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977018738",
            "telephone_number": "541-382-5712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAUTMAN",
        "first_name": "STEPHANIE",
        "middle_name": "ALICE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-24",
        "last_updated": "2016-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OR",
            "license": "MD28337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.