Willamette General & Colon-Rectal Surgery PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD20653 Issued in OR

Legal business name

WILLAMETTE GENERAL & COLON-RECTAL SURGERY PC

Practice address

19875 SW 65TH Ave
Suite 260
Tualatin, OR 97062-8353

Phone

(503) 691-1743

Fax

(503) 691-0983

NPI assigned

Nov 4, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Brent K Evetts, M.D.NPI 1538291547

Title

Owner/Physician

Phone

(503) 691-1743

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brent K Evetts, M.D.

  • Surgery Physician
  • Tualatin, OR
  • NPI 1538291547

  Specialist

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410220800000",
    "number": "1396736518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19875 SW 65TH AVE",
            "address_2": "SUITE 260",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970628353",
            "telephone_number": "503-691-1743",
            "fax_number": "503-691-0983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19875 SW 65TH AVE",
            "address_2": "SUITE 260",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970628353",
            "telephone_number": "503-691-1743",
            "fax_number": "503-691-0983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLAMETTE GENERAL & COLON-RECTAL SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-04",
        "last_updated": "2014-09-09",
        "status": "A",
        "authorized_official_last_name": "EVETTS",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "503-691-1743",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "OR",
            "license": "MD20653",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "R105002",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150330",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1375470",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000035001",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN",
            "identifier": "3007286-01",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacob White, PHARMD
• Miriam Krisitiyahna White, OTD, OTR/L
• Rachel Finn White, DPT
• Jason Wilkinson
• Willamette Dermatology, P.C.
• Willamette General & Vascular Surgery, P.C.
• Willamette Hematology-Oncology PC
• Willamette Orthotics & Prosthetics LLC
• Willglow Psychiatry and Wellness Services
• Sandi Dawn Williams, CSWA

• Specialist in Tualatin, OR
• Providers in Tualatin, OR by specialty
• Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.