Larry R Eidemiller, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

MD07236 Issued in OR

Practice address

1130 NW 22ND Ave
Suite 500
Portland, OR 97210-2900

Phone

(503) 229-7339

Fax

(503) 229-7938

NPI assigned

Jun 26, 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Surgical Associats, PC

  • Surgery Physician
  • Portland, OR
  • NPI 1821019860
  NPD (past)

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211414400000",
    "number": "1447287701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9155 SW BARNES RD",
            "address_2": "SUITE 830",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256625",
            "telephone_number": "503-229-7339",
            "fax_number": "503-229-7938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 NW 22ND AVE",
            "address_2": "SUITE 500",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102900",
            "telephone_number": "503-229-7339",
            "fax_number": "503-229-7938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EIDEMILLER",
        "first_name": "LARRY",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2008-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OR",
            "license": "MD07236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "234799",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erin Eichenberger, LMT
• Alisa Eichler
• Charlene Eickholt, PH.D.
• Aya Eid, MD
• Caitlyn Eid
• Tess Elizabeth Eidson
• Phyll Eier, DO
• M. Patrice Eiff, MD
• Lucy Eigen
• Christine Marcou Eighmey, PNP

• Surgery Physician in Portland, OR
• Providers in Portland, OR by specialty
• Surgery Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2008; 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.