Active NPI
Cassidy Mooney
- Contractor
- Bend, OR
National Provider Identifier
1366803827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 10096
- Practice address
- 1045 NW Bond St
Bend, OR 97703-2043 - Phone
- (541) 610-4291
- NPI assigned
- Mar 11, 2016
- Last updated
- Mar 11, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 10096 | OR | Primary |
Addresses
Primary practice location
1045 NW Bond St
Bend, OR 97703-2043
Mailing address
1147 NE Viking CT
Bend, OR 97701-3961
Phone (541) 610-4291
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20150413 | Other | EBMS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10096 | OR | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1457654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457654400000",
"number": "1366803827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1147 NE VIKING CT",
"city": "BEND",
"state": "OR",
"postal_code": "977013961",
"telephone_number": "541-610-4291"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1045 NW BOND ST",
"city": "BEND",
"state": "OR",
"postal_code": "977032043",
"telephone_number": "541-610-4291"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOONEY",
"first_name": "CASSIDY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-03-11",
"last_updated": "2016-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "OR",
"license": "10096",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EBMS",
"identifier": "20150413",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.