Kyle O'Hara

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11466 Issued in OR

Practice address

913 A St
Myrtle Point, OR 97458-1334

Phone

(541) 559-5000

Fax

(541) 516-4035

NPI assigned

Jul 1, 2021

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

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1625097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625097600000",
    "number": "1346810231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "442 SW UMATILLA AVE STE 200",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977567039",
            "telephone_number": "888-468-0022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "913 A ST",
            "city": "MYRTLE POINT",
            "state": "OR",
            "postal_code": "974581334",
            "telephone_number": "541-559-5000",
            "fax_number": "541-516-4035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'HARA",
        "first_name": "KYLE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-01",
        "last_updated": "2021-07-01",
        "certification_date": "2021-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D11466",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D11466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Robert Gronemyer, DDS
• Edmund Reed Gurney Jr., MD
• David Yim Lee, MD
• Myrtle Point of Cascadia, LLC
• New Creations LLC 1111
• Kaylie Marie Parrish
• Michelle L Petersen, RPH
• Alex Mario Rangel
• Sapphire at Myrtle Creek LLC
• Sapphire at Myrtle Point, LLC

• General Practice Dentistry in Myrtle Point, OR
• Providers in Myrtle Point, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.