NPIMap

Organization Active NPI

Rogue Valley Physicians

Doing business as Southern Oregon Internal Medicine

  • Primary Care Clinic/Center
  • Medford, OR
National Provider Identifier
1285851071
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
ROGUE VALLEY PHYSICIANS
Doing business as
Southern Oregon Internal Medicine
Practice address
2900 Doctors Park Dr
Medford, OR 97504-8127
Phone
(541) 282-2208
Fax
(541) 282-2237
NPI assigned
Apr 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Vicki S Wagner, CPA
Title
Ceo
Phone
(541) 282-2208

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

2900 Doctors Park Dr
Medford, OR 97504-8127

Mailing address

2900 Doctors Park Dr
Medford, OR 97504-8127
Phone (541) 282-2208

Other names 1

  • SOUTHERN OREGON INTERNAL MEDICINE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040608000628 OR Part B Supplier - Clinic/Group Practice 1850374240 Receives reassigned benefits from 21 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Medford, OR

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Cancer Care of Southern Oregon7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2900 Doctors Park Dr
Ste 200
Medford, OR 97504
Phone (541) 282-2200

Practitioners & affiliated clinicians

Practitioners 5

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": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285851071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 DOCTORS PARK DR",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048127",
            "telephone_number": "541-282-2208",
            "fax_number": "541-282-2237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 DOCTORS PARK DR",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048127",
            "telephone_number": "541-282-2208",
            "fax_number": "541-282-2237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGUE VALLEY PHYSICIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-282-2208",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTHERN OREGON INTERNAL MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.