Joseph R Tibay, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

966795 Issued in OR

Practice address

330 Chiloquin Blvd
Chiloquin, OR 97624-6747

Phone

(541) 882-1487

Fax

(541) 783-3237

NPI assigned

Feb 7, 2012

Last updated

Dec 12, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX, OR2 enrollments

Enrollment records 2

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Klamath Tribal Health and Family ServicesGroup PAC ID 9032027206, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: joseph.tibay.p1@direct.kthfs.nextgenshare.com

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.

• Klamath Tribal Health & Family Services

  • Federally Qualified Health Center (FQHC)
  • Chiloquin, OR
  • NPI 1629078274
  Medicare reassignment Care Compare group NPD
• Chemawa Indian Health Center DHHS IHS Western Oregon Serv Unit

  • Multi-Specialty Clinic/Center
  • Salem, OR
  • NPI 1578565347

  TX

  Medicare reassignment
• Klamath Tribal Health & Family Services

  dba Klamath Tribal Pharmacy - Klamath Falls

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Klamath Falls, OR
  • NPI 1730879446
  NPD

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

{
    "created_epoch": "1328572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670803200000",
    "number": "1326310335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3949 SOUTH 6TH STREET",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "97603",
            "telephone_number": "541-882-1487",
            "fax_number": "541-880-5590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 CHILOQUIN BLVD",
            "city": "CHILOQUIN",
            "state": "OR",
            "postal_code": "976246747",
            "telephone_number": "541-882-1487",
            "fax_number": "541-783-3237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIBAY",
        "first_name": "JOSEPH",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-02-07",
        "last_updated": "2022-12-12",
        "certification_date": "2022-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OR",
            "license": "966795",
            "primary": true
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NU",
            "license": "966795",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500735399",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDR REGISTRATION",
            "identifier": "966795",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gerald B Ramos, DDS
• Jamie D. Rich, M.D.
• Melissa Sample, FNP
• Benjamin Russel Stuart, DNP, APRN, FNP-C
• Shaymaa Taha
• Ashley Marie Vandeberghe, MA
• Tess Wolvert
• Qiang Yin, M.D.

• Registered Dietitian in Chiloquin, OR
• Providers in Chiloquin, OR by specialty
• Registered Dietitian in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.