Individual provider Active NPI

Keerti Jaini, MD

  • Internal Medicine Physician
  • Coos Bay, OR
National Provider Identifier
1386908598
Registry record updated Jul 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD171157 Issued in OR
Practice address
1900 Woodland Dr
Coos Bay, OR 97420-2045
Phone
(541) 267-5151
NPI assigned
Jul 2, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X MD171157 OR Primary

Addresses

Primary practice location

1900 Woodland Dr
Coos Bay, OR 97420-2045

Mailing address

1900 Woodland Dr
Coos Bay, OR 97420-2045
Phone (541) 267-5151

Other identifiers 5

IdentifierTypeStateIssuer
R0000WFBTVOtherORNORTH BEND MEDICAL CENTER GROUP MEDICARE
93-0635514OtherORNORTH BEND MEDICAL CENTER GROUP TAX ID
1407812365OtherORNORTH BEND MEDICAL CENTER GROUP NPI
500688655MedicaidOR
161133OtherORNORTH BEND MEDICAL CENTER GROUP MEDICAID

Medicare participation

Medicare enrollment files
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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150730013448 OR Practitioner - Internal Medicine 6002120326 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Bend Medical Center IncGroup PAC ID 5597677716, 92 clinicians

Practice addresses (Care Compare)

1900 Woodland Dr
Coos Bay, OR 97420-2045
Phone (541) 267-5151

Hospital & facility affiliations

  • Bay Area Hospital Hospital, Coos Bay, OR, CCN 380090
  • Coquille Valley Hospital Hospital, Coquille, OR, CCN 381312
  • Curry General Hospital Hospital, Gold Beach, OR, CCN 381322
  • Sacred Heart Medical Center - Riverbend Hospital, Springfield, OR, CCN 380102
  • Southern Coos Hospital & Health Center Hospital, Bandon, OR, CCN 381304

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Bay Area Hospital District CurrentSince Sep 1, 2016 Accepting new patients
North Bend Medical Center Inc CurrentSince Sep 1, 2015 Accepting new patients
Bay Area Hospital District CurrentSince Sep 1, 2016 Accepting new patients

Locations

Dept LA 25339
Pasadena, CA 91185

1900 Woodland Dr
Coos Bay, OR 97420
Phone (541) 267-5151

2650 N 17th St
Coos Bay, OR 97420
Phone (541) 267-5411

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1341187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438214400000",
    "number": "1386908598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 WOODLAND DR",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202045",
            "telephone_number": "541-267-5151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 WOODLAND DR",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202045",
            "telephone_number": "541-267-5151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAINI",
        "first_name": "KEERTI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-02",
        "last_updated": "2015-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD171157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH BEND MEDICAL CENTER GROUP MEDICARE",
            "identifier": "R0000WFBTV",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH BEND MEDICAL CENTER GROUP TAX ID",
            "identifier": "93-0635514",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH BEND MEDICAL CENTER GROUP NPI",
            "identifier": "1407812365",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500688655",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH BEND MEDICAL CENTER GROUP MEDICAID",
            "identifier": "161133",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coos Bay, OR

Sources for this page

Verify at the official NPI Registry.