Jay N Gade, MD PHD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD20360 Issued in OR

Practice address

2440 NW Edenbower Blvd
Roseburg, OR 97471-8847

Phone

(541) 957-1141

Fax

(541) 957-1466

NPI assigned

Feb 2, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jay N. Gade M.D., PHD., PC

  • Specialist
  • Roseburg, OR
  • NPI 1841439312
  NPD Authorized official
• Jay N. Gade, MD, PHD, PC

  • Dermatology Physician
  • Roseburg, OR
  • NPI 1255520383
  NPD (past) Authorized official

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

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311724800000",
    "number": "1447222724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2440 NW EDENBOWER BLVD",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974718847",
            "telephone_number": "541-957-1141",
            "fax_number": "541-957-1466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2440 NW EDENBOWER BLVD",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974718847",
            "telephone_number": "541-957-1141",
            "fax_number": "541-957-1466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GADE",
        "first_name": "JAY",
        "middle_name": "N",
        "credential": "MD PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-02",
        "last_updated": "2011-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OR",
            "license": "MD20360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150092",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelly Robyn Fultz, LPN
• Jacqueline Jill Fummerton, RN
• Kellie Fusco
• G Jason Wilks DPM PC
• Judy Diane Gabehart-Geant, M.ED., L.P.C.
• Frederick Carl Gaestel
• Kelli Renee Gaffield, FNP
• Suzann Adrienne Gage, APNP, WHNP-BC
• Tiffany Gage, LCSW, CDC I
• Candida Gagliano

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.