Active NPI
John William Rollings, M.D.
- Family Medicine Physician
- Salem, OR
National Provider Identifier
1376673467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 12174
- Practice address
- 435 Lancaster Dr NE
Salem, OR 97301-4729 - Phone
- (503) 585-6388
- Fax
- (503) 585-0669
- NPI assigned
- Mar 7, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 12174 | OR | Primary |
Addresses
Primary practice location
435 Lancaster Dr NE
Salem, OR 97301-4729
Mailing address
236 Rees Hill Rd SE
Salem, OR 97306-9111
Phone (503) 585-2303
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 066498 | Medicaid | OR | |
| M4003 01 | Other | OR | PACIFIC SOURCE |
| 0057325873360 | Other | OR | REGENCE BCBS OF OREGON |
| 0169990022 | Other | OR | PROVIDENCE HEALTH PLANS |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12174 | OR | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392595200000",
"number": "1376673467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "236 REES HILL RD SE",
"city": "SALEM",
"state": "OR",
"postal_code": "973069111",
"telephone_number": "503-585-2303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "435 LANCASTER DR NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973014729",
"telephone_number": "503-585-6388",
"fax_number": "503-585-0669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROLLINGS",
"first_name": "JOHN",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-07",
"last_updated": "2014-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "12174",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "066498",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PACIFIC SOURCE",
"identifier": "M4003 01",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BCBS OF OREGON",
"identifier": "0057325873360",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROVIDENCE HEALTH PLANS",
"identifier": "0169990022",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.