NPIMap

Organization Active NPI

Paul D. Reicherter, MD, PC

  • Clinical & Laboratory Dermatological Immunology Physician
  • Roseburg, OR
National Provider Identifier
1407055437
Registry record updated Feb 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical & Laboratory Dermatological Immunology PhysicianTaxonomy code 207NI0002X
License
MD23536 Issued in OR
Legal business name
PAUL D. REICHERTER, MD, PC
Practice address
1813 W Harvard Ave Ste 310
Roseburg, OR 97471-2756
Phone
(541) 672-7546
Fax
(541) 957-8446
NPI assigned
Jul 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2016

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

Authorized official

Name
Paul D Reicherter, MDNPI 1053379826
Title
President
Phone
(541) 672-7546

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X MD23536 OR
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X MD23536 OR
Clinical & Laboratory Dermatological Immunology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NI0002X MD23536 OR Primary
Pediatric Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NP0225X MD23536 OR
Procedural Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NS0135X MD23536 OR

Addresses

Primary practice location

1813 W Harvard Ave Ste 310
Roseburg, OR 97471-2756

Mailing address

1813 W Harvard Ave Ste 310
Roseburg, OR 97471-2756
Phone (541) 672-7546

Other identifiers 5

IdentifierTypeStateIssuer
286785MedicaidOR
286785OtherOROHP
838392000OtherORBCBS
38D1028702OtherORCLIA
DC5977OtherMEDICARE RAILROAD

Other names 1

  • Advanced Skin Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040817000008 OR Part B Supplier - Clinic/Group Practice 4082687298 Receives reassigned benefits from 23 practitioners
Practice locations: Coquille, OR; Grants Pass, OR; Reedsport, OR; Roseburg, OR

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D1028702Advanced Skin Center1813 W Harvard Suite 310, Roseburg, OR 97471ComplianceNov 2, 2026

National Provider Directory

National Provider Directory

Locations

855 W Central Blvd
Ste B
Coquille, OR 97423

1021 NE 6th St
Grants Pass, OR 97526
Phone (541) 507-1881

1021 NE 6th St
Ste 201
Grants Pass, OR 97526

1813 W Harvard Ave
Ste 310
Roseburg, OR 97471
Phone (541) 672-7546

Practitioners & affiliated clinicians

Practitioners 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1184112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455494400000",
    "number": "1407055437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1813 W HARVARD AVE STE 310",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974712756",
            "telephone_number": "541-672-7546",
            "fax_number": "541-957-8446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1813 W HARVARD AVE STE 310",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974712756",
            "telephone_number": "541-672-7546",
            "fax_number": "541-957-8446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL D. REICHERTER, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-11",
        "last_updated": "2016-02-15",
        "status": "A",
        "authorized_official_last_name": "REICHERTER",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-672-7546",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "OR",
            "license": "MD23536",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "OR",
            "license": "MD23536",
            "primary": false
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": "OR",
            "license": "MD23536",
            "primary": true
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "OR",
            "license": "MD23536",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "OR",
            "license": "MD23536",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "286785",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHP",
            "identifier": "286785",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "838392000",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "38D1028702",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DC5977",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Skin Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Roseburg, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.