NPIMap

Individual provider Active NPI

Bryan Tolle, D.O.

  • Family Medicine Physician
  • La Grande, OR
National Provider Identifier
1275878894
Registry record updated Jun 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS018207 Issued in PA
Practice address
506 4TH St
La Grande, OR 97850-1906
Phone
(541) 663-3138
NPI assigned
Dec 7, 2012
Last updated
Jun 2, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Family Medicine Physician 207Q00000X OS018207 PA Primary
General Practice Physician 208D00000X 510102115 MI

Addresses

Primary practice location

506 4TH St
La Grande, OR 97850-1906

Mailing address

506 4TH St
La Grande, OR 97850-1906
Phone (541) 663-3138

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, OR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180329001143 PA Practitioner - Family Practice 8628294394 Reassigns benefits to 1 organization
I20200415003152 OR Practitioner - Family Practice 8628294394 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grande Ronde Hospital IncGroup PAC ID 0547170789, 97 clinicians

Practice addresses (Care Compare)

900 Sunset Dr
La Grande, OR 97850-1362

900 Sunset Dr
La Grande, OR 97850-1387
Phone (541) 963-8421

PO Box
Suite 3290
La Grande, OR 97850

PO Box
Suite 3290
La Grande, OR 97850-7290

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS018207PAMDFamily Medicine Physician
510102115MIMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Grande Ronde Hospital, Inc. Family Medicine CurrentSince May 1, 2020 Accepting new patients
Guthrie Medical Group, P.C. Family Medicine CurrentSince Mar 12, 2018 Accepting new patients
Guthrie Medical Group, P.C. Family Medicine CurrentSince Mar 12, 2018 Accepting new patients
Grande Ronde Hospital, Inc. CurrentSince May 1, 2020 Accepting new patients
Guthrie Medical Group, P.C. Family Medicine Current Accepting new patients

Locations

506 4th St
La Grande, OR 97850
Phone (541) 663-3138

900 Sunset Dr
La Grande, OR 97850
Phone (541) 963-8421

1 Guthrie Sq
Sayre, PA 18840
Phone (570) 887-3106

285 Guthrie Dr
Troy, PA 16947
Phone (570) 297-4104

Interoperability endpoints

  • Direct secure messaging: btolle1242929@wm.providencedirect.org

Organizations & group practices 5

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.

Hospital & facility affiliations 8

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": "1354838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591056000000",
    "number": "1275878894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 4TH ST",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978501906",
            "telephone_number": "541-663-3138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 4TH ST",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978501906",
            "telephone_number": "541-663-3138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOLLE",
        "first_name": "BRYAN",
        "name_prefix": "Mr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-12-07",
        "last_updated": "2020-06-02",
        "certification_date": "2020-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS018207",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "510102115",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Grande, OR

Sources for this page

Verify at the official NPI Registry.