Premier Wound Healing

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

PREMIER WOUND HEALING

Practice address

320 SW Century Dr Ste 405-392
Bend, OR 97702-3037

Phone

(541) 280-6201

Fax

(541) 280-6201

NPI assigned

Feb 16, 2023

Organization subpart

No

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

Authorized official

Name

Leslie Carter, MDNPI 1730168014

Title

Owner

Phone

(541) 280-6201

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00404

Practitioners 5

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

• Leslie Ann Carter, MD

  • Dermatology Physician
  • Bend, OR
  • NPI 1730168014
  Medicare reassignment Authorized official
• Marie Drabek, NP

  • Family Nurse Practitioner
  • Bend, OR
  • NPI 1427718097
  Medicare reassignment NPD
• David Joseph Gahtan, P.A.

  • Physician Assistant
  • Portland, OR
  • NPI 1215903059
  Medicare reassignment
• Heidi Lind Holmes, PA-C

  • Medical Physician Assistant
  • Bend, OR
  • NPI 1861829517
  Medicare reassignment
• Lionel P Marx, PA

  • Medical Physician Assistant
  • Happy Valley, OR
  • NPI 1013268200
  Medicare reassignment

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

{
    "created_epoch": "1676505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711584000000",
    "number": "1407554819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13709 210TH ST E",
            "city": "GRAHAM",
            "state": "WA",
            "postal_code": "983386625",
            "telephone_number": "541-280-6201",
            "fax_number": "877-684-8059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 SW CENTURY DR STE 405-392",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023037",
            "telephone_number": "541-280-6201",
            "fax_number": "541-280-6201"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8352 W Foothill Dr",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "AZ",
            "postal_code": "853832035",
            "country_code": "US",
            "telephone_number": "602-290-1664",
            "fax_number": "855-224-1695",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7970 Fredricksberg Rd. Suite 101 #361",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782293891",
            "country_code": "US",
            "telephone_number": "915-208-0487",
            "fax_number": "877-308-6294",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11364 SW Lunata Way",
            "address_purpose": "LOCATION",
            "city": "Port St Lucie",
            "state": "FL",
            "postal_code": "349878804",
            "country_code": "US",
            "telephone_number": "772-380-5606",
            "fax_number": "866-397-6617",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PREMIER WOUND HEALING",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-16",
        "last_updated": "2024-03-28",
        "certification_date": "2024-03-26",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-280-6201",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "163WW0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, Wound Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Bend, OR
• Providers in Bend, OR by specialty
• Dermatology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; 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.