NPIMap

Organization Active NPI

Siskiyou Vital Medicine LLC

  • Primary Care Clinic/Center
  • Medford, OR
National Provider Identifier
1407442338
Registry record updated Dec 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
SISKIYOU VITAL MEDICINE LLC
Practice address
940 Ellendale Dr # 102
Medford, OR 97504-8216
Phone
(541) 210-5687
Fax
(541) 392-4962
NPI assigned
Dec 15, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2020

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

Authorized official

Name
Mr. Gregory McClane Duncan, NDNPI 1700289626
Title
Owner/Member
Phone
(541) 210-5687

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X
Community Health Clinic/Center 261QC1500X
Infusion Therapy Clinic/Center 261QI0500X
Multi-Specialty Clinic/Center 261QM1300X
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

940 Ellendale Dr # 102
Medford, OR 97504-8216

Mailing address

940 Ellendale Dr # 102
Medford, OR 97504-8216
Phone (541) 210-5687

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Elation Direct

National Provider Directory

National Provider Directory

Locations

940 Ellendale Dr
#102
Medford, OR 97504
Phone (541) 210-5687

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1607990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607990400000",
    "number": "1407442338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "940 ELLENDALE DR # 102",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048216",
            "telephone_number": "541-210-5687",
            "fax_number": "541-392-4962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 ELLENDALE DR # 102",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048216",
            "telephone_number": "541-210-5687",
            "fax_number": "541-392-4962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SISKIYOU VITAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-15",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A",
        "authorized_official_last_name": "DUNCAN",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "MCCLANE",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "541-210-5687",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ND"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Elation",
            "affiliation": "N",
            "endpointDescription": "Electronic Medical Record",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "940 Ellendale Dr # 102",
            "city": "Medford",
            "state": "OR",
            "country_code": "US",
            "postal_code": "975048216",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.