NPIMap

Organization Active NPI

Douglas Medical Group, LLC

  • Family Medicine Physician
  • Roseburg, OR
National Provider Identifier
1346578861
Registry record updated Dec 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DOUGLAS MEDICAL GROUP, LLC
Practice address
1813 W Harvard Ave
Suites 110, 201, 422, 426
Roseburg, OR 97471-2752
Phone
(541) 957-3079
Fax
(541) 464-4641
NPI assigned
Nov 20, 2009
Last updated
Dec 17, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2009

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

Authorized official

Name
Ms. Jamie L Warner
Title
Assistant Manager
Phone
(547) 957-3079

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU
Pediatrics Physician 208000000X NU
General Practice Physician 208D00000X NU

Addresses

Primary practice location

1813 W Harvard Ave
Suites 110, 201, 422, 426
Roseburg, OR 97471-2752

Mailing address

1813 W Harvard Ave
Suite 448
Roseburg, OR 97471-2752
Phone (541) 957-3079

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1258675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261008000000",
    "number": "1346578861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1813 W HARVARD AVE",
            "address_2": "SUITE 448",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974712752",
            "telephone_number": "541-957-3079",
            "fax_number": "541-464-4641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1813 W HARVARD AVE",
            "address_2": "SUITES 110, 201, 422, 426",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974712752",
            "telephone_number": "541-957-3079",
            "fax_number": "541-464-4641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOUGLAS MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-20",
        "last_updated": "2009-12-17",
        "status": "A",
        "authorized_official_last_name": "WARNER",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ASSISTANT MANAGER",
        "authorized_official_telephone_number": "547-957-3079",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseburg, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.