Active NPI
Stevens Cloyd Marshall, D.O.
- Family Medicine Physician
- Boardman, OR
National Provider Identifier
1396740585
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 02001282
- Practice address
- 450 Tatone St
Boardman, OR 97818-8076 - Phone
- (541) 481-7212
- Fax
- (541) 481-5400
- NPI assigned
- Jun 15, 2005
- Last updated
- Mar 22, 2018
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 02001282 | IN | Primary |
| General Practice Physician | 208D00000X | 02001282 | IN |
Addresses
Primary practice location
450 Tatone St
Boardman, OR 97818-8076
Mailing address
PO Box 397
Boardman, OR 97818-0397
Phone (541) 481-7212
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 268743 | Other | IN | BLUE CROSS BLUE SHIELD |
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 Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02001282 | IN | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Columbus Urgent Care Center | Family Medicine | Past | Accepting new patients |
| X-Ray Consultants Inc | Past | Accepting new patients | |
| Middlebury Urgent Care &Occmed, P.C. | General Practice | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521676800000",
"number": "1396740585",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 397",
"city": "BOARDMAN",
"state": "OR",
"postal_code": "978180397",
"telephone_number": "541-481-7212",
"fax_number": "541-481-5400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 TATONE ST",
"city": "BOARDMAN",
"state": "OR",
"postal_code": "978188076",
"telephone_number": "541-481-7212",
"fax_number": "541-481-5400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARSHALL",
"first_name": "STEVENS",
"middle_name": "CLOYD",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-15",
"last_updated": "2018-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "02001282",
"primary": true
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "IN",
"license": "02001282",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "268743",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boardman, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.